Poppy For Medicine

Poppy for Medicine
Licensing poppy cultivation for the production of essential

medicines: an integrated counter-narcotics, development,
and counter-insurgency model for Afghanistan
June 2007
Afghan village-based Poppy for Medicine projects
June 2007
June 2007
Contents
Executive Summary
Introduction
11
Box
Morphine: a simple poppy-derived pain medicine remains the worlds

most effective painkiller
Part A: Poppy for Medicine: an integrated counter-narcotics and

counter-insurgency model
A1
Reining in the Afghan Poppy through the integrated control of

Poppy for Medicine projects
17
Summary
1.
Controlling the implementation of Poppy for Medicine projects
2.
Who are the key players in the Integrated Control System?
Box
Key concept in Poppy for Medicine projects: Village Control
3.
Controlled planning of individual village-level Poppy for Medicine projects
4.
Controlling each project phase: policing responsibilities and penalties
Box
Integrated Control of Poppy for Medicine project
A2
Bringing economic development at the village level
41
Summary
1.
The economics of Poppy for Medicine Projects: production and sale of

medicines
Box
Afghan National Pharma Company: International Morphine Traders
Box
Case Study Poppy for Medicine project: local transformation into medicines
brings an additional 150% value to villages harvest
2.
June 2007
The economic vehicle of Poppy for Medicine projects: cooperative

associations
3.
Economic Diversification through Poppy for Medicine projects
A3
Merits of Poppy for Medicine project as an integrated counternarcotics and counter-insurgency model
59
Summary
1
Entrenching the rule of law and enhancing loyalty to the Afghan government
2.
Providing the resources and incentives necessary to phase out reliance on

poppy
Foiling the corruption associated with counter-narcotics efforts
Immediately bridging security and development in Afghanistan
A4
Scientific Pilot Projects
1.
Control and Legal Framework
2.
Timeline, Planning and Implementation
3.
Number and Location of Pilot Projects
4.
Employment
71
Part B: Afghan-made medicines to meet the global need for

painkillers
B1
The global supply, use, and need for essential poppy-based medicines 83
Summary
1.
Demand and supply: the current poppy-based medicines production system
Box:
Un-met need for painkillers in Latin America
2.
The global un-met need for morphine
Box:
WHO efforts to increase prescription of poppy-based medicines
Box:
Afghan morphine needed to meet actual global need for painkillers
B2
June 2007
Afghan medicines to be sold under a second-tier system of medicine

supply for emerging countries
1.
The need for a second tier of medicines supply to complete current system
2.
Channelling Afghan-made medicines to the international market through
99
special trade agreements

Box
Special trade agreements for Afghan-made medicines
B3
Pilot projects needed to test the use of Afghan-made morphine
Box:
Brazil: a Pilot Project to provide pain relief
Box:
Supplying morphine to UN agencies and international NGOs
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June 2007
June 2007
Executive Summary
Poppy for Medicine in Afghanistan: an integrated grassroots counternarcotics and counter-insurgency model
Afghanistan faces an unprecedented security and reconstruction crisis
Resolving Afghanistans illegal opium crisis is the key to the international
communitys successful stabilisation and development of the country. Yet, by overemphasising failed counter-narcotics strategies such as forced poppy eradication, the
United States-led international community has aggravated the security situation,
precluding the very reconstruction and development necessary to remove Afghan
farmers need to cultivate poppy.
Current counter-narcotics policies are risking mission failure in Afghanistan

In 2006 Afghanistan produced 92% of the worlds total illegal opium. The size of the
illegal opium economy is threatening the development and reconstruction process by
weakening the rule of law and jeopardising the legitimacy of the Afghan government.
Yet the counter-narcotics policies currently being pursued in an attempt to resolve
Afghanistans poppy crisis are fuelling support for the Taliban and the insurgency. In
particular, the failure to deliver promised livelihoods alternative to illegal poppy
cultivation has caused disillusionment and increased distrust. The Taliban is
capitalising on this and the forced eradication of poppy crops to increase its support
base within rural farming communities.
If these foreigners really care about the people of Afghanistan, then why do they
destroy our crops; why do they deprive us from the only source of our livelihood,
without providing us with any alternative? Is this fair?
June 2007
Local leader, Kama District, Nangarhar Province, May 20061

Afghanistans opium crisis is no longer a mere counter-narcotics problem. It has
become one of the main impediments to the success of the international
communitys mission in the country: until Afghanistans poppy crisis is
positively and sustainably addressed, the countrys security and development
crises cannot be resolved.
An integrated economic solution to Afghanistans poppy and insurgency crises
Based on extensive on-the-ground research, ICOS has developed a Poppy for
Medicine project model for Afghanistan as a means of bringing illegal poppy
cultivation under control, and building support for the international communitys
counter-insurgency mission in an immediate yet sustainable manner. It involves
licensing the controlled cultivation of poppy to produce essential poppy-based
medicines such as morphine, with unlicensed poppy cultivation remaining a criminal
activity. Poppy licensing for the production of medicines is an alternative counternarcotics strategy that has been successfully implemented in many countries.2
Tailored to the realities of Afghanistan, Poppy for Medicine projects would link the
countrys two most valuable resources - poppy cultivation and strong local village
control systems - to secure the controlled cultivation of poppy for the local production
of morphine. The resulting economic benefits would provide farming communities
with access to the strategic economic assets necessary to end their reliance on poppy
cultivation. The key feature of the Afghan Poppy for Medicine project model is that
village-cultivated poppy would be transformed into morphine tablets in the Afghan
1
Ali Wardak, Integrated Social Control in Afghanistan: Implications for the Licensed Cultivation of
Poppy for the Production of Medicines, ICOS, May 2006, [online] Available at:
http://www.icosgroup.net/modules/reports/Integrated_Social_Control_Afghanistan
2
Poppy for Medicine projects were established in Turkey in the 1970s with the support of the United
States and the United Nations, as a means of breaking farmers ties with the international illegal heroin
market without resorting to forced poppy crop eradication. Within just four years, this strategy
successfully brought the countrys illegal poppy crisis under control. See ICOS, A Political History of
Poppy Licensing in Turkey, May 2006, [online] Available at:
http://www.icosgroup.net/modules/reports/Turkey_Poppy_Licensing_Political_History
The Indian Government has also successfully licensed the cultivation of poppy for the production of
medicines as a means of controlling the countrys poppy cultivation. For further discussion of this, see
Romesh Bhattacharji, Case Study: Indias experiences in licensing poppy cultivation for the
production of essential medicines lessons for Afghanistan, June 2007, [online] Available at:
http://www.icosgroup.net/modules/reports/India_case_study
8
June 2007
villages. The entire production process, from seed to medicine tablet, can thus be
controlled by the village in collaboration with government and international actors,
and all economic profits from medicine sales would remain in the village, triggering
economic diversification. As internationally tradable commodities, locally-produced
medicines would also benefit the Afghan government.
Integrated security systems provide maximum physical and quality control

By transforming poppy into morphine medicines in Afghan villages, the entire poppy
cultivation system can be controlled at three levels, by maximising Afghanistans
renowned tradition of strong local control systems. Poppy for Medicine project
villages, with the support of government actors and international development and
security experts, can secure and provide quality control the entire manufacturing
process, from the seeds to the final medicine tablets. Exported directly from the
villages to Kabul and international markets in tablet form, the trade in locally
produced medicines can be completely secured.
Grassroots economic development necessary to win locals hearts and minds
Locally owned and operated, these village-based poppy control models would have
beneficial ink-blot effects on security and economic development in the regions
around the villages, and thus complement the international communitys mission in
Afghanistan. As an economic development-orientated counter-narcotics initiative,
Poppy for Medicine projects would impact significantly on the international
communitys efforts to counter the insurgency. Field research has revealed that the
vast majority of current insurgents are driven primarily by economic incentives. These
insurgents join the insurgency because they have no jobs and no way to feed their
families. By triggering economic development in rural communities and integrating
these communities within the Afghan legal economy and government system, the
Poppy for Medicine projects would decrease insurgents recruitment bases.
Creating vested interests in the Poppy for Medicine project

In Poppy for Medicine projects, the local transformation of raw poppy materials into
medicines would bring the inherent economic value of poppy directly to the village,
thereby providing strong economic incentives for rural communities to permanently
terminate their links with drug traffickers. Able to access a stable livelihood, rural
9
June 2007
communities would be provided with a real choice between the illegal and legal
economy, and a real opportunity to support the Karzai government. As such,
Poppy for Medicine projects would provide project communities with a vested interest
in protecting the projects.
Poppy for Medicine model adaptable to local conditions

The village-based Poppy for Medicine project model is grounded in proven, local
control systems which were documented in extensive sociological and criminological
field research undertaken throughout 2005 and 2006. The model can be easily adapted
to the specific circumstances of different regions of Afghanistan, where Poppy for
Medicine projects are most needed.
An Afghan-owned solution to the Global Pain Crisis

The locally-based production of poppy-based medicines in Poppy for Medicine
projects would not only reduce illegal opium and heroin production in Afghanistan,
they would also provide emerging and transitional countries with access to affordable
essential painkilling medicines. According to the International Narcotics Control
Board whose mandate is to ensure an adequate supply of morphine for medical and
scientific purposes, 80 percent of the worlds population, including Afghans, face an
acute shortage of essential morphine medicines. Further, pain experts have
highlighted that even when these medicines are available, patients often face
significant affordability problems. There is a clear the need to find structural solutions
to enhancing the affordability of controlled medicines. Exported under special trade
frameworks from Afghan villages for use within the region and around the world,
Afghan village-produced morphine would provide a structural solution to help address
the global demand for affordable essential painkillers. Extensive field research and
economic modelling demonstrates that Afghanistan could supply this market with
medical morphine at a price at least 55 percent lower than the market average.
Towards a scientific pilot project

ICOS offers this Technical Dossier to the Afghan government and the international
community for their urgent attention. This initial research should be followed up by a
scientific pilot project that further tests the parameters and specification of the villagebased Poppy for Medicine model, starting in the next planting season.
10
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11
June 2007
Introduction
As the raw material for essential painkilling medicines such as morphine, if carefully
controlled, the opium poppy can be a positive resource, both for economic
development, and to bring illegal drug production under control. This Poppy for
Medicine Technical Dossier comprises a blueprint for the implementation of
integrated grassroots-level counter-narcotics and counter-insurgency projects. These
projects are village-based Poppy for Medicine schemes; through which small Afghan
village-based organisations are licensed to locally produce simple poppy-based
medicines, for sale by the Afghan government to meet the growing global need for
affordable painkilling medicines.
Morphine: a simple poppy-derived pain medicine remains the worlds most
effective painkiller
The benchmark to which all new painkilling medicines are measured, morphine is the
gold standard in pain management, and forms the basis of treatment for pain around
the world.3
A nineteenth century medicine, morphine was discovered in 1805. The extraction of
morphine from raw poppy materials is relatively simple, requiring inexpensive
chemicals and simple chemical processes, and ten kilograms of raw poppy materials
yields approximately one kilogram of morphine medicines.
While in the past morphine was used to treat everything from insomnia to alcohol
abuse, today morphine forms the bedrock of pain management for patients suffering
from all moderate to severe pain, including pain associated with HIV/AIDS and
cancer. On the World Health Organisations Model List of Essential Medicines,
morphine is considered the worlds most effective painkiller.
International Narcotics Control Board, Estimated World Requirements for 2006, part 4, p 78 [online].
Available at: http://www.incb.org/pdf/e/tr/nar/2005/narcotics_part4_en.pdf,
12
June 2007
The licensed cultivation of poppy for the production of medicines has important
precedents as a counter-narcotics strategy, and indeed, Afghanistans current Counter
Narcotics Law provides for the implementation of poppy licensing schemes.4 Based
on this law, on international precedents (see box), and on extensive field research, a
Poppy for Medicine project model has been developed which is tailored to the
complexities of Afghanistan.5
Community control the key condition for Poppy for Medicine Project licence
The initiative would not provide a blanket license for all Afghan farming communities
to grow poppy and produce opium. Rather, specific farming communities would be
licensed by a central government agency to implement Poppy for Medicine projects to
locally produce morphine medicines under tightly controlled and highly monitored
conditions. Receipt of these licences would carry three conditions: the
unavailability of sustainable livelihoods alternative to poppy cultivation in a
potential project village;6 a community-wide commitment to the elimination of
drug trafficking in the areas under community control; and an undertaking to
implement economic diversification activities.
Poppy for Medicine project model is compliant with international law

Providing for the production and export of finished poppy-based medicines, the
Poppy for Medicine project model would not unbalance the international system of
raw poppy materials supply, and would therefore comply with the regulations of the
1961 Single Convention on Narcotic Drugs, the international legal instrument which
governs the production and export of raw poppy materials from supply countries to
4
Islamic Republic of Afghanistan, Counter Narcotics Law, Article 7, paragraph 3, [online] Available
at: http://www.mcn.gov.af/eng/downloads/documents/drug_law.pdf. Notably, Turkey benefited from a
similar project in the 1970s with the support of the United States and the United Nations, as a means of
breaking farmers ties with the international illegal heroin market without resorting to forced poppy
crop eradication. Within just four years, this strategy successfully brought the countrys illegal poppy
crisis under control. For more information see Political History of Poppy Licensing in Turkey, [online]
Available at:
http://www.icosgroup.net/modules/reports/Turkey_Poppy_Licensing_Political_History
5
These realties are that two of Afghanistans existing resources strong local control systems and
poppy cultivation expertise can be leveraged to provide access to the capital and other strategic assets
necessary to end farming communities reliance on poppy.
6
The official Afghan Counter-Narcotics Strategy provides that unless sustainable alternative
livelihoods are available, forceful counter-narcotics operations should not be implemented: Islamic
Republic of Afghanistan Ministry of Counter-Narcotics, National Drug Control Strategy: an Updated
Five-Year Strategy for Tackling the Illicit Drug Problem, Kabul. 2006, [online] Available at:
http://www.fco.gov.uk/Files/kfile/NDCSfinal%20_Jan%202006.pdf
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manufacturing countries.7 Further, the finished morphine medicines exported from

Afghanistan would only be sold to those countries currently lacking access to
affordable pain medicines. As such, Afghan-made medicines would not compete with
current international medicine suppliers.8
International precedent for poppy licensing as an alternative to forced
eradication
In 1970 the US offered financial compensation in return for the eradication of poppy
in Turkey. The Turkish government refused, emphasising the political weight of the
70,000 poppy farming families, with Prime Minister Demirel saying eradication
would create a clash between the government forces and the people, and would make
the problem worse, since it would create public support for plantings.9 Turkey
insisted that eradication would bring down the government,10 and US memos from
this period indicate that the Nixon administration was fully aware that further
pressure to eradicate could topple the Demirel government.11
In 1970 the Turkish government decided to pursue the implementation of a poppy
licensing system for the production of medicines.12 Acknowledging that licensed
Turkish opium would help resolve the global shortage of poppy-based painkillers, the
United States began to support the Turkish poppy licensing programme, extending
special protected market status to Turkey under a Drug Enforcement Agency
Regulation, commonly known as the 80-20 Rule.13
The Poppy for Medicine project complies with international regulations as laid down in the 1961
Single Convention on Narcotic Drugs and its protocols. The INCB enforces the self-contained supply
and demand system that the convention instigated: Countries are authorised to demand raw poppy
materials only according to an estimate based on the amount used in the two previous years. Supply
countries can only produce the poppy necessary to fulfil this estimated global demand and must be
authorised by ECOSOC to export raw opium-based materials.
8
This non-competitor aspect is a result of the essential differences between Afghan village-based
Poppy for Medicine projects and the Indian licensed poppy cultivation programme. The extensive
benefits brought to participating Afghan communities through the projects would provide the strong
incentives necessary for these communities to completely rule out the diversion that plagues Indias
licensed poppy cultivation projects.
9
Telegram 1957 from the Embassy in Turkey to the Department of State, (April 2, 1970), in: Foreign
Relations.
10
Ibid.
11
Bureau of Intelligence and Research, Intelligence Note; Turkey: Waiting for the New Governments
Opium Program, April 30, 1971 in: Foreign Relations.
12
Memorandum From Secretary of State Rogers to President Nixon, Washington, (July 28, 1970), in:
Foreign Relations.
13
Drug Enforcement Agency Regulation Law 1312.13.
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15
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Part A
An integrated counter-narcotics and
counter-insurgency model
16
June 2007
Part A1
Reining in illegal poppy cultivation through the integrated
control of Poppy for Medicine projects
17
June 2007
18
A1
June 2007
Reining in the Afghan Poppy
Summary
Based on a realistic analysis of the economic benefits of the illegal opium trade,
village-based Poppy for Medicine projects are economic development-orientated
counter-narcotics initiatives designed to help Afghan farming communities to end
their reliance on illegal poppy cultivation. In doing so, Poppy for Medicine projects
would help win back the hearts and minds of rural Afghan communities, thereby
complementing the international communitys stabilisation efforts in the country.
As the name suggests, the local production of poppy-based medicines lies at the heart
of the projects. The guiding concept of village-based Poppy for Medicine projects is
that the profits on sales of these locally-produced, globally sought-after medicines
would provide the economic, social, and structural means to end rural Afghan
communities reliance on illegal poppy cultivation, and in doing so, provide the
incentives necessary to trigger these communities committed participation in
countering illegal poppy cultivation in Afghanistan.
Projects secured through integration of existing security and control institutions

Village-based Poppy for Medicine projects are akin to an alternative counter-narcotics
strategy that has been successfully implemented in many other countries. It involves
licensing the controlled cultivation of poppy to produce essential poppy-based
medicines such as morphine; whilst unlicensed poppy cultivation remains illegal. The
most important issue to address in implementing poppy licensing systems is attaining
and maintaining high levels of control over the licensed cultivation of poppy. To meet
the international and domestic legal requirements regarding the production of poppybased medicines, and in response to the current security situation and the growing
pervasiveness of drug trafficking in Afghanistan, ICOS has developed an Integrated
19
June 2007
Control System to secure and control village-based Poppy for Medicine projects.14 By
monitoring, policing, and regulating every aspect of a Poppy for Medicine project, the
Integrated Control System would make possible the smooth, secure manufacture of
medicines in Afghanistan. In addition, the Integrated Control System provides for the
application of appropriate penalties if necessary.
Three levels of integrated control

The three sets of actors involved in the Integrated Control System are the village-level
governance institutions known as shuras; the Afghan governments relevant
Ministries, district governments, and the state-controlled Afghan National Police; and
the international communitys development agencies currently operating in
Afghanistan. The integration of Afghan villages existing informal local level social
control structures with formal government administrative and security oversight and
international development and security institutions for the control of Poppy for
Medicine projects would maximise the capacities and aptitude of each for the efficient
and extensive policing, monitoring and sanctioning of the projects. Further, the
positive relationships such integration would engender would complement the
ongoing efforts of each to defeat the insurgency, and stabilise and develop
Afghanistan.
Physical security, logistical security, and quality control assured

In particular, the Integrated Control System would secure and control the physical
safety of project participants, by preventing disruption of a project by drug traffickers;
and would prevent diversion of raw poppy materials by ensuring that project
participants permanently terminate their links with drug traffickers. As well as
ensuring that all raw poppy products are transformed into medicines, the Integrated
Control System also provides for extensive quality control throughout the entire
medicine production process. With the support of international development agencies,
medicine production experts would monitor and supervise trained, qualified staff to
ensure the locally-produced medicines meet international quality standards including
those in
the
International
Pharmacopoeia
and the
WHO-endorsed
Good
14
Ali Wardak, Integrated Social Control in Afghanistan: Implications for the Licensed Cultivation of
Poppy for the Production of Medicines, ICOS, May 2006, [online] Available at:
20
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Manufacturing Practice Guidelines, and comply with the relevant national

requirements of importing countries.15 The production and export of locally-produced
medicines would bring significant revenues to the local economy and trigger
development. Through the Integrated Control System, the advice and support of
international development experts would allow for this development to be controlled
and maximised.
15
See for example the World Health Organisations Good Manufacturing Practices, [online] Available
at: http://www.who.int/medicines/publications/pharmacopoeia/overview/en/index.htm
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June 2007
22
1.
June 2007
Controlling the implementation of Poppy for Medicine projects
Providing the foundation for the success of an entire programme of Poppy for
Medicine projects, the local planning process would be pivotal.16 Decisions taken
during this phase would not only ensure that the medicines produced under Poppy for
Medicine projects would meet international export standards, they would also ensure
that the implementation of the projects in particular villages is transparent and the
implementation process is able to be duplicated elsewhere in the country where
integrated counter-narcotics and counter-insurgency projects are needed.
1.1
District-level perspective needed to implement Poppy for Medicine

projects
To achieve the best balance between the security, logistical and quality control
requirements associated with producing poppy-based medicines in Afghanistan, the
planning and implementation of Poppy for Medicine projects must take place at the
district level, and include input from district government officials, local powerholders, and other stakeholders.17 A district-level planning perspective is needed
because project modelling indicates that individual Poppy for Medicine projects
would be most secure and generate maximum economic impact when implemented in
a district-wide project cluster. These clusters would consist of a series of 5-10
individual village-based projects, together with a special district-level Poppy for
Medicine facility for the manufacture of poppy-based medicines, which would be
jointly-owned and operated by the individual village projects.
District-level planning facilitates selection of individual project villages

Whilst the ultimate decision on the exact locations of individual village-based Poppy
for Medicine projects would rest with the Afghan government, district-level planning
16
Throughout this document, the phrase Poppy for Medicine will be used interchangeably with P4M.
Officially, Afghanistans 400 districts represent the outer limits of the Afghan central governments
control over the country. While this control is centred on the district government office of the
Wolaswal who interacts with village shuras, many districts are also heavily influenced by local powerholders not officially associated with the Afghan government. Nothing happens within the regions
under the control of these power-holders without their knowledge and implicit agreement. As such, in
planning and implementing Poppy for Medicine projects, it would be necessary to work closely with
these power-holders to guarantee the security of projects within the district. Such cooperation would
help to integrate these power-holders into the new Afghanistan, by providing a real opportunity for
them to build positive relationships with the institutions of the central Afghan government.
17
23
June 2007
would facilitate the close involvement of district-level governance structures and

other local power-holders necessary to selecting any one project village over another.
The district-level planning would allow the Afghan government to benefit from the
unique
insights
of
districts
security and economic situation

provided by district administrators,
local power-holders and other stakeholders, thereby allowing for the
implementation
of
Poppy
for
Medicine projects within individual

villages
in
which
economic
development is both most needed,

and most likely to be sustainable.
P4M Project village selection criteria

When selecting villages within which to implement
Poppy for Medicine projects, a number of criteria
will need to be taken into account:
Social and Political criteria:
Unavailability of other alternative development
projects;
Commitment of local leadership to compulsory
economic diversification;
Strong local social cohesion;
Geographical criteria:
Access to a road network to transport materials;
Agricultural criteria:
Agricultural land and climate suitable for optimal
medicinal poppy cultivation;
Access to securable, irrigated land;
Local poppy farming expertise;
District-level implementation facilitates meeting of international legal requirements

The district-level implementation of Poppy for Medicine projects would also facilitate
the meeting of the international legal requirement that poppy licensing schemes be
administered by a special government agency.18 Such an agency has already been
established under the 2005 Afghan Counter-Narcotics: the Committee for Drug
Regulation. Representatives from this committee could be attached to the existing
district governance institutions to coordinate the Afghan governments administrative
oversight and security support for Poppy for Medicine projects.19
District-level implementation maximises quality control of medicines produced in

As indicated above, Poppy for Medicine projects would need to be implemented in
clusters of 5-10 individual village-based projects, together with a special districtlevel Poppy for Medicine transformation factory for the manufacture of poppy-based
medicines. Such a factory would enable the processing of individual project villages
18
As set out in articles 23 and 29 of the 1961 Single Convention on Narcotic Drugs, to implement a
poppy licensing programme for the production of poppy-based medicines, a state must establish a
National Government Agency to provide administrative oversight of the poppy licensing programme.
19
The formal institutions of the Afghan central government are represented at the district level by the
Wolaswali. While the office of the local administrator, the court of justice, and the police unit
constitute the core of the wolaswali, this district government institution also includes units of finance,
national census, communications, land ownership, and the office of the district level attorney general.
24
June 2007
dried and tested poppy harvests into finished medicines of international export
quality, and would provide a secure environment for the sale of each village projects
quantity of finished medicines to the Afghan government.20 To facilitate government
oversight and international development support in controlling the quality of medicine
production processes, this district-level Poppy for Medicine transformation factory
would be located at the seat of the district government, and jointly managed and
operated by representatives from the individual village projects. The management and
operation of this transformation factory by representatives from the individual village
projects would provide the careful local control necessary to prevent corruption and
diversion.
The selection of the actual districts within which clusters of Poppy for Medicine
projects would be implemented would be a decision for the Afghan government,
in conjunction with provincial governments, in consultation with security
support actors such as the Afghan National Police and the international
communitys development agencies.
20
Throughout the transformation process, individual village-based Poppy for Medicine projects would
retain legal ownership of their projects raw materials, (evidenced through clear documentation) and
eventual revenues from sales of medicines to the Afghan government would be based on the quantity of
finished medicines produced from their raw materials.
25
2.
June 2007
Who are the key players in the Integrated Control System?
Comprising three sets of actors with varying levels of influence over the actions of
Afghanistans rural farming communities, the Integrated Control System has the
capacity to completely police and regulate every aspect of both individual villagebased projects and entire clusters of Poppy for Medicine projects, and to apply
appropriate penalties if necessary.
2.1
Village Shura: Social control
The Integrated Control System leverages the unique information-gathering and

information-sharing capacities of Afghan community shuras to provide the pivotal
levels of control for the implementation and operation of individual village-based
Poppy for Medicine projects. As the foundation of the Integrated Control System,
shuras would both ensure the buy-in of project participants, and manage the running
of the actual projects.
Shuras retain maximum influence over socio-economic activities of Afghan villages

Shuras are community-level governance structures which strictly enforce social norms
and behaviour at all levels of social and economic interaction in rural Afghan
communities, through the principle of collective responsibility. The high level of
influence shuras hold over the day-to-day actions of the inhabitants of their
communities can be explained through an examination of the four pyramidal
structural levels of authority within which social control is divided in rural
Afghanistan. At the bottom of the pyramid are the extended family units known as
koronay,
within
which
communitys social values are

internalised. At the mid-level of
the social control pyramid are the
small kinship group-based kalays
(small village), which comprise
several koranay, and are governed
by small groups of family elders
known
as
jirga.
At
Why is the inclusion of shuras so pivotal?

As the countrys strongest economic and political units,
Afghan villages represent the necessary focal points for
grassroots counter-narcotics initiatives such as Poppy
for Medicine projects. Because most of Afghanistans
poppy is cultivated by rural communities, counternarcotics strategies must focus on empowering rural
communities to end their reliance on illegal poppy
cultivation. Deeply influential on village life, the shura
not only has the necessary geographical proximity, it
also has the legitimacy and authority to establish,
regulate and control an entire communitys committed
participation in a Poppy for Medicine project.
the
26
June 2007
penultimate layer of the pyramid is the larger qaria (village), made up of several
kalays, and supervised by a shura. The shura coordinates and resolves issues of
importance for the entire qaria and its individual members.21
Shura acts as a project communitys guarantor
As the primary controllers of Poppy for Medicine projects, shuras, and the
communities they govern, would effectively operate as each others co-guarantors.
Accountable to their communities, shuras would guarantee Poppy for Medicine
projects bring significant benefits to the project participants and the villages. In return,
shuras would guarantee their entire communitys committed participation in a Poppy
for Medicine project. If either the shura or a community member defaulted on their
commitments to the project, the entire project village would lose its licence to
cultivate poppy for medicinal purposes, and thus its access to significant economic
benefits.
As institutions of justice, decision-making, and social control, shuras can apply a

range of strong sanctions as preventative, corrective and punitive measures against
community members. While extensive sociological and criminological field research
strongly indicates that the social pressure from fellow community members and
leaders would ensure that project participants do not compromise the security and
control of a Poppy for Medicine project, an important element in the control and
security of Poppy for Medicine projects would be to establish at the planning phase
known measures to discourage potential improper behaviour.
Suitable to the Afghan rural community context, these measures would take the form
of strict sanctions, which would be decided upon by the village shura and enacted by
the entire community. These may include simple fines or the loss of a position as an
21
The top level of the pyramidal system of control is the district government, the Wolaswali. For
further discussion of the capacity of local community-level governance structures to influence the
actions of members of Afghanistans villages, see Ali Wardak, Integrated Social Control in
Afghanistan: Implications for the Licensed Cultivation of Poppy for the Production of Medicines, May
2006,
[online].
Available
at:
27
June 2007
active project participant, or the more severe punishment of ratal the collective
social boycott of an individual.22
Key concept in Poppy for Medicine projects: Village Control

Economic rationale: local production of medicines
In the global market for poppy-based medicines, finished medicines are significantly
more valuable than their raw poppy materials. Poppy for Medicine projects would
bring this value to Afghan villages, by exploiting Afghan villages existing
cooperative structures to locally produce morphine through the pooling of the
villages resources.
Security rationale: security and control of medicine production
As well as making possible the actual production of medicines, basing Poppy for
Medicine projects in villages allows for each phase of the entire medicine production
process to be secured through the villages governance and collective social control
systems.
Underlying sociological rationale
Through their strong social control systems based on reciprocal relationships, Afghan
villages can effectively guarantee the committed participation of Afghanistans
farming communities in Poppy for Medicine projects. The value brought to the village
through the local production and sale of morphine would provide villages with
sufficient incentives to do so.
2.2
Afghan local and central government: Administrative control; Quality

control; and support for Physical control
The careful documentation and close security monitoring of Poppy for Medicine
projects by relevant local and central Afghan government institutions would meet the
requirements of the international regulations governing the production of poppy-based
medicines. Perhaps more importantly however, the close involvement of relevant state
institutions in the Integrated Control System would provide important opportunities
22
Ratal is applied when a party to a dispute under the jurisdiction of the shura chooses not to adhere to
the shuras resolution of that dispute. Because the shura is the voice of the whole community, if
someone rejects that voice, the whole village will stand against that person.
28
June 2007
for positive contact between the Afghan government, its district-level representatives,
and rural farming communities.
As one of rural Afghanistans
most
important
institutions,
the
security
state-directed
Afghan National Police would

have the capacity to provide the
additional
security
support
necessary to ensure the complete
Why is state support important for control?

As well as adding a vital layer of control to Poppy for
Medicine projects, by facilitating collaboration in the
countering of illegal poppy cultivation through local
economic development, the overseeing of Poppy for
Medicine projects will provide a significant opportunity
for Afghanistans institutions of state control to build
constructive relationships with rural communities. In
particular, the integration of the Afghan National Army
in the control of Poppy for Medicine projects will
provide the ANA with a positive way of implementing
counter-narcotics strategies.
physical control of Poppy for

Medicine projects. In exercising physical and bureaucratic control of Poppy for
Medicine projects, Afghan local and central government authorities would have
recourse to official legal sanctions.
2.3
International development agencies: economic development and quality

control
The third level of control in the Poppy for Medicine project model would be to ensure
that the locally-produced medicines are of high-value export quality, and that the
profits from sales of these medicines are channelled into the economic development
necessary to end participating communities reliance on poppy cultivation. Through
the Kabul-based provision of training, advice, and ongoing monitoring, international
development experts would facilitate quality control in the medicine production
process. By providing experts to advise on and monitor economic diversification
projects
funded by
medicines
sales, representatives from the

international
communitys
development agencies operating in

Afghanistan
would
help
to
maximise the economic impact of

Poppy
ensuring
for
Medicine
their
projects,
success
as
grassroots economic development-
Why include international development agencies?

Economic rationale: In Afghanistan, international
development agencies such as DFID or CIDA have
almost unparalleled access to development expertise and
funding: their assistance from Kabul with the economic
control of Poppy for Medicine projects would
effectively guarantee the maximum economic impact of
the projects.
Political rationale: Representing the international
community to Afghans, DFID and CIDA integration
would build grassroots support for the ongoing security
and stabilisation mission, and would also provide a
practical, positive way for the international community
to support the Afghan government in resolving the
countrys illegal opium crisis.
and counter-narcotics initiatives.

29
3.
June 2007
Controlled planning of individual village-level Poppy for

Medicine projects
Once selected, villages lead planning and consultation phase

As local institutions of collective decision-making, the village shura would lead the
planning discussions and consultations to decide on the precise format, timing, and
parameters of a village-based Poppy for Medicine project. The project village shuras
inside knowledge regarding key issues would be absolutely necessary to ensure that
the setting of project parameters provides for the sustainable phasing out of the
villages reliance on poppy.
Poppy for Medicine projects would be implemented in clusters of villages within a

district; as these villages would share the use of a processing facility, it would be
necessary to convene a group meeting of all the shuras from villages operating as part
of that project cluster. This meeting would allow decisions to be made on how the
individual projects would operate together as a complete Poppy for Medicine project;
and how the district processing facility would be managed, operated and controlled.
3.1
Setting key project parameters
Prior to the implementation of each village-based Poppy for Medicine project, a

number of important decisions would need to be made regarding various project
elements which would affect the projects immediate and ongoing impact on
economic development and illegal poppy cultivation. In making these decisions, the
shura would receive administrative and security support from the Afghan government
institutions, and economic development advice from international development
agencies. To ensure the smooth implementation and to facilitate the ongoing
administration of Poppy for Medicine projects, the decisions taken by the shura
during the planning phase would be extensively documented.
3.2
Agreement on formal project format
The formal format of the project would determine the number of project participants,
and the ways in which the revenues from sales of locally produced medicines would
be distributed to project participants. To facilitate the actual manufacture of poppy-
30
June 2007
based medicines and the fair sharing out of revenues from sales of these medicines, it
would be necessary for the village to establish a formal entity which would employ
project participants. As a locally owned and operated business entity, this organisation
would be regulated and controlled by the shura.23
The shura would need to determine the roles and required numbers of active or
more general project participant positions, and nominate villagers to be engaged in
these roles each project year, according to various criteria such as aptitude (for
training as a laboratory technician or administrator), access to securable land (for
farmers), farming experience (for harvesters), and commitment to the project aims
(for security guards).24 In such a project format, other villagers not actively engaged
in a specific capacity would still play a role in helping to secure the project village, by
monitoring other project participants and reporting potential spoilers to the shura.
3.3
Decisions on accrual and dispersal of revenues from medicine sales to

project participants
On behalf of the active project participants, the shura would also need to decide the
manner in which revenues would be distributed, via the formal village business entity,
to the various project participants. Depending on the needs of the project village, it
might be necessary to disburse revenue payments to project participants gradually
over the length of the project, similar to wages or a salary. Alternatively, the shura
could choose to make lump sum payments to project participants at the end of a
project cycle, once the locally-produced medicines have been sold. Further, the shura
could decide that villagers needs would best be met using a split lump sum payment
system, whereby a proportion of the project participants eventual share of the
revenues is delivered upfront to cover their costs throughout the project, with the
remainder dispersed at the end of the project cycle.
An essential element of the village-based Poppy for Medicine counter-narcotics

model is compulsory economic diversification to phase out reliance on poppy
cultivation. This economic diversification can be facilitated by allocating a
23
For further discussion of this formal village business entity, see section Part A2, section 2.2
As a way of further ensuring the support of all stakeholders for Poppy for Medicine projects, local
power-holders could nominate some of their personal security guards to be approved by the project
village shura for employment as project security guards.
24
31
June 2007
significant proportion of the revenues from sales of locally-produced medicines into a

special village account or fund, from which villagers could draw on to finance new
business opportunities and community projects.25 The proportion of the revenues from
medicine sales that would be channelled into such an economic diversification fund,
and the ways in which project participants would access this fund would depend on
the agreed upon project format. In a larger village Poppy for Medicine project in
which not all villagers play an active role, the remuneration of the more general
project participants would consist of access to the village economic diversification
fund under micro-finance principles.
3.4
In
Define project participant roles

consultation
with
potential
project
participants,
Afghan
government
representatives, and international development experts, the shura would need to

generate specific job descriptions and selection criteria for each role within the Poppy
for Medicine project. These job descriptions would then determine the pay grade or
proportion of the revenues the project participants in particular roles would receive. A
project would require a number of land-holding farmers to cultivate the poppy raw
materials, a larger number of farm workers to harvest the materials, trained
technicians to transform the raw poppy materials into finished medicines, as well as
record-keepers, security guards, and project leaders or supervisors. The shura would
then nominate those villagers who meet the selection criteria for engagement in the
project.26
The important role of farmers in Poppy for Medicine projects

The role of the farmers in a Poppy for Medicine project is particularly important.
Responsible for the successful cultivation and harvesting of the raw poppy materials
25
Similar programmes have been successfully implemented by the World Bank and the Aga Khan
Network. The World Banks Emergency Community Empowerment and Public Works Project
triggered economic development and strengthened governance at the community level by channelling
grants through community councils which planned and managed small reconstruction and development
projects. For more information see The World Bank, Afghanistan: Status of Projects, [online]
Available at:
http://www.worldbank.org.af/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/AFGHANIST
ANEXTN/0,,contentMDK:20143800~menuPK:347173~pagePK:141137~piPK:141127~theSitePK:305
985,00.html#nsp
26
With the support of international development experts, those villagers engaged to be laboratory
technicians would then receive extensive training in the transformation of raw poppy materials into
finished medicines. With the support of the Afghan National Army, those villagers engaged to be
security guards would then receive extensive training in security.
32
June 2007
from which the medicines would be manufactured, those villagers engaged as project
farmers would be using their own land for the benefit of the entire village. As such,
the shura would also need to decide whether project farmers would receive additional
payments for the use of their land and/or the quantity and quality of the raw poppy
materials produced by the farmer.
3.5
Set projects annual timeline
Using its unique insights into a project villages agricultural and economic cycles, the
shura would also determine the precise timing of the production of poppy-based
medicines, in terms of cultivation, harvest, transformation period.27 In consultation
with village farmers, the shura would decide on the necessary agricultural inputs for
the project and the optimal planting period, and would generate initial estimates as to
the timing of the harvest and potential yield.28 In conjunction with international
development experts, these estimates would then be used to develop initial models
and plans for economic diversification.
27
A recent case study of Indias experiences of licensing poppy cultivation for the production of
medicines provides a detailed description of the licensed poppy cultivation cycle and timeline. See
Romesh Bhattacharji, Case Study: Indias experiences in licensing poppy cultivation for the
production of essential medicines lessons for Afghanistan, June 2007, [online] Available at:
http://www.icosgroup.net/modules/reports/India_case_study
28
According to the UNODC, the exact timing of the opium poppy harvest is determined by the variety
of the opium poppy cultivated, the time of sowing and most importantly climatic conditions in the
district. Consequently, the timing of the harvest in any one district may differ by a number of days from
one year to the next. For instance, the harvest in Nawzad, Helmand Province was reported to begin ten
days earlier in 1999 than it had in the previous year due to particularly warm weather. From UNODC,
Access to Labour: The role of opium in the livelihood strategies of itinerant harvesters working in
Helmand province, Afghanistan, Strategic Study #4, June 1999, [online] Available at:
http://www.unodc.org/pakistan/en/report_1999-06-30_1_page005.html#H
33
4.
June 2007
Controlling each project phase: policing responsibilities and

penalties
4.1
Project participant engagement phase
Following nomination by the local shura, the selection and engagement of the active
participants in a Poppy for Medicine project would be documented by representatives
from Afghan state institutions, to provide official administrative oversight of the
project. Once engaged, the Afghan National Police would support the shura in the
training of these participants in any necessary additional security measures. This
support from external security actors would ensure their visual familiarity with project
participants, thereby enhancing the external security supporters capacity to assist the
village in its exclusion of non-project participants from secure project zones.
4.2
Cultivation phase
Throughout the cultivation phase, the project village shura would distribute
agricultural inputs to project farmers, and ensure that the seeds are sown only on
project land. As part of a poppy licensing systems legal requirements, relevant
Afghan government monitors would measure and document this project land.
Following germination of the seeds, the shura would supervise the destruction of
excess seedlings, to ensure they are not re-planted on non-project land. Throughout
the cultivation phase the shura would monitor the ongoing inputs necessary to limit
crop losses through disease and environmental effects.
During the cultivation phase, Afghan

government
administrators
would
use the shuras knowledge of project

villagers agricultural outputs to
implement an anti-diversion measure
used in the Indian
Penalties for cultivation phase offences

Attempts by project participants to relocate
excess seedlings to non-project land will be
recorded by Afghan government administrators,
and penalised accordingly by the shura.
Attempts by drug traders to disrupt the project
will be monitored and dealt with by the shura
with the support of the Afghan National Police.
Poppy for
Medicine system, known as the Minimum Qualifying Yield.29 This would involve
recording the shuras estimates of project farmers eventual yields of raw poppy
29
The Minimum Qualifying Yield (MQY) is a very important diversion-prevention measure. The
MQY is the minimum yield of raw poppy materials that a licence-holder must produce each harvest, or
risk severe penalties, including the loss of his or her license. The MQY is set according to historical
34
June 2007
materials. A failure on the part of farmers to then deliver this minimum estimated
yield at harvest time would indicate possible diversion, leaving the farmer open to
sanctions.
The policing of the cultivation phase by the shura and Afghan government
administrators would be further enhanced through the integrated support from the
Afghan National Police, who would monitor at the district level any outside interest
in the projects, pre-empting possible spoilers. In the final months of the cultivation
phase, this external security support would be gradually built up to provide targeted
security of the individual project villages as the crop matures. However, the primary
safeguard against drug traffickers would be the villagers in a Poppy for Medicine
project. Field research findings clearly show that the specific elements that comprise
Afghan local social control systems are extremely active in protecting the best
interests of their communities. If an activity, such as Poppy for Medicine projects, is
in a communitys interest, the village community is completely willing and able to
close ranks to secure the project against the influence of outsiders such as the Taliban,
insurgents, or drug traffickers.
4.3
Harvest phase
In terms of project security, the

harvest period would be one of the
most important phases in a Poppy
for Medicine project. As such, all
decisions and actions taken during
this phase would need to be made
under the supervision of external
security
supporters,
and
in
Penalties for harvest phase offences

Attempted diversion by harvest workers will be
treated extremely severely: the village project
would lose its Poppy for Medicine licence
Further, offenders would face a range of penalties
from both the shura and the counter-narcotics
authorities. To ensure respect for human rights, for
project evaluation purposes, the application of these
penalties would be documented by external
monitors.
Inexplicable failures to meet estimated final yields
would be penalised as diversion.
consultation with all project stakeholders. The shura, in consultation with the project
farmers and external security support would decide when to begin the harvest, would
take delivery of and document the daily harvest, supervise the inspection of harvest
workers at the end of each harvest day, and in conjunction with external security
yield levels. The MQY is set at a level that leaves no excess harvest for the licensee to divert into the
illegal market. These estimates would need to be adjusted throughout the cultivation phase to take
account of environmental factors which would impact on eventual yields of raw poppy materials.
35
June 2007
support, the shura would secure the harvest in special storage facilities. To facilitate
the physical security of the project village, the shura would also share villagers
ongoing reports of non-project participants and potential spoilers in the vicinity of the
project village with external security supporters.
Poppy harvests in Afghanistan are relatively small (35-40 kg per hectare), and all
farmers and villagers know from experience exactly how much can be harvested each
day. With the harvest securely stored each day in clearly labelled, measurable
containers, the shura and Afghan government monitors would be able to keep careful
track of the precise harvests collected each day, from the field to the medicine
laboratory.
4.4
Medicine production phase
The transformation of raw poppy

materials into finished medicines
would be another key phase in a
Poppy
Careful
for
Medicine
project.
documentation
and
supervision from trained project

participants, in conjunction with
central and district government
administrators, would track the
entire
harvest
to
prevent
diversion and to ensure that the
Penalties for medicine production phase offences

Any disruption of the medicine production process,
intentional or otherwise by project participants will be
penalised by the shura, and any attempted or actual
disruption of the medicine production process by nonproject participants will be prosecuted under the
Afghan counter-narcotics laws.
Attempted diversion by laboratory workers will be
treated extremely seriously, and offenders will face a
range of penalties from both the shura and the
counter-narcotics authorities.
Failure to provide documentary evidence that the
entire harvest, as received daily from the shura
throughout the harvest phase is processed into
medicines will be treated as diversion.
Failures to meet medicine manufacturing quality
control standards will be prosecuted under Health
regulations.
medicines would not be further

transformed into illegal drugs.
The process necessary to transform raw poppy materials into finished medicines
would begin during the harvest period, during which trained project participants
within the individual project villages would dry the daily harvest of raw poppy
36
June 2007
materials.30 These dried materials would then be tested within the village for
morphine content, the result of which would determine payment to farmers.
With the support of external security actors, project villages would then securely
transport their dried, tested raw materials to the district processing facility for
transformation into medicines. The morphine content of these raw materials would
then be tested again, and the results documented by government administrators.31
Under the supervision of pharmaceutical experts, the raw materials would then be
processed into morphine medicines, and the entire production process would be
subject to stringent quality control tests, administered with the support of experts
supplied by international development agencies. The complete physical security of the
district processing facility would be ensured through security support from the Afghan
National Police.
4.5
Sale and export of medicines phase
Coordinated by the representatives from individual project villages managing the

district processing facility, the finished medicines would then be sold directly from
the district processing facility to the district branch of the Committee for Drug
Regulation, on behalf of the Afghan government. Building on its records of a villages
medicine production output, these Afghan government administrators would verify
the full purchase of all medicines manufactured in a village during one project cycle.
With support from the Afghan
National
districts
Police,
participating
security
guards
would then securely transport the

purchased medicines to Kabul by
road or by air for local use in
Afghan
hospitals
and
as
an
Penalties for sale and delivery phase offences

With all locally-produced medicines to be sold to the
Afghan government, a failure for sales
documentation to match production documentation
will be prosecuted as diversion by the Afghan
government.
Upon delivery, the failure of delivery documents to
match sales documents will be prosecuted as
diversion by the Afghan government.
Attempted or actual interruption of the delivery
process will be prosecuted as diversion and theft
under Afghan counter-narcotics and criminal laws.
international export commodity.
30
Raw poppy materials can be dried to the consistency required for medicine manufacture within 4-5
days. During the day, the raw materials are exposed to direct sunlight in special trays, and stirred
continuously. The trays are then stored securely at night.
31
Indicating the quantity of finished morphine medicines that a project villages raw materials would
yield, this test result would form the basis of a transformation contract between the individual project
villages formal business entity and the district processing facility.
37
4.6
June 2007
Receipt of medicine revenues, and economic diversification phases
Representatives from the individual project villages in charge of managing the district
processing facility would take receipt of payments for the district-produced medicines
from the Afghan government. Dispersal of these payments to each project village
would be made according to the quantity and quality of medicines produced from an
individual village-based Poppy for Medicine projects raw materials.32
Individual project shuras would then oversee the dispersal of this payment to
individual project participants, according to the payment parameters set out during the
project planning phase (see Part A1, section 3.1), and would channel a proportion of
these revenues into a special village fund for economic diversification. In this way,
the shura would begin to discharge its co-guarantor duty to ensure that Poppy for
Medicine projects result in economic diversification. With the support of external
development experts from international development agencies, and documented by
Afghan government administrators, the shura would identify, select, and arrange the
funding and implementation of village-level economic diversification projects. Also
with the support of external development experts, the shura would advance microloans to project participants to fund individual economic diversification activities.
4.7
Evaluation phase
At the end of each Poppy for Medicine project production cycle, the entire project
would be evaluated. As well as evaluating individual project participants
involvement in the project, the shura would evaluate the quantitative evolution of
sales, losses and profit as well as the profitability ratios, with the support of
international development experts. These would be used to assess the economic
impact of the project. The Afghan National Police would be required to provide an
evaluation of its involvement in the
project, and to generate securityrelated
recommendations.
The
Afghan government would assess
Offences identified during evaluation phase

Any offences by members of the Afghan National
Police committed while controlling a Poppy for
Medicine project and identified in evaluation would
be prosecuted under Afghan counter-narcotics and
criminal law.
the capacity of the Integrated

32
Throughout the medicine production process, individual Poppy for Medicine project villages would
retain legal ownership of the raw materials produced by that project village, and the medicines they
yield.
38
June 2007
Control System to secure the project throughout each phase, and would generate
overall recommendations to enhance the capacity of Poppy for Medicine projects to
rein in illegal poppy cultivation.
Summary: Integrated Control of Poppy for Medicine projects
Project Phases
and Control
actors
1. Planning
Shura
Afghan
government
Afghan National
Police and local
power-holders
International
Development
Experts
Primary control
Select project
format;
Decide on accrual
and dispersal of
profits to project
participants;
Define project
roles;
Establish project
timeline
Secondary control
Document shuras
planning decisions
Tertiary control
Provide advice to
shura regarding
project security
roles;
Develop project
security guidelines
Tertiary control
Provide advice to
shura regarding
project format and
project roles;
Develop economic
diversification
guidelines
2. Engagement
of project
participants
Primary control
Receive
nominations of
potential project
participants;
Engagement based
on aptitude and
character
Secondary control
Supervise
engagement
process;
Exclude known
and potential
spoilers based on
known criteria
Tertiary control
Provide additional
security guards
Train project
participants in
security
procedures
Tertiary control
Train project
participants in
medicine
manufacturing
procedures
3. Cultivation
Primary control
Distribute
agricultural inputs;
Supervise planting
of seeds
Monitor ongoing
agricultural inputs
needs
Secondary control
Measure and
document project
fields
Record Shuras
estimates of final
yield
Tertiary control
Supervise access
to project fields
Monitor outside
interest in project
Tertiary control
Provide advice on
agricultural inputs
to enhance final
yield
Develop economic
models based on
estimated final
yields
4. Harvest
Secondary control
Decide to begin
harvest
Supervise
inspection of
harvest workers
Take delivery of
and secure daily
harvest
Tertiary control
Document daily
harvest
Document
preparation of
daily harvest for
transformation
Document final
harvest yield
Primary control
Monitor and
inspect harvest
workers
Maintain security
of project fields
Secure the drying
process
Tertiary control
Provide experts to
assist in quality
control of the
drying of daily
harvest in
preparation for
transformation
into medicines
5. Medicine
production
Secondary control
Provide
supervisors to
district processing
facility to inspect
medicine
manufacturing
workers
Secondary control
Provide to district
processing
facilities with
Tertiary control
Document
medicine
manufacturing
process
Secondary control
Secure medicine
production
laboratory
Primary control
Provide experts to
assist in quality
control of
medicine
manufacturing
process
Secondary control
Purchase
medicines on
behalf of Afghan
Primary control
Secure delivery of
medicines to
Afghan
Tertiary control
Adjust economic
diversification
model based on
6. Sale and
delivery of
medicine
39
7. Dispersal of
medicine sales
revenues and
economic
diversification
8.
Evaluation
June 2007
representatives to
coordinate the sale
of medicines to
Afghan
government on
behalf of project
village
Primary control
Disperse revenues
to project
participants
Select and fund
village-level
economic
diversification
projects
government
Document
reception of
medicines
government
final medicine
sales
Tertiary control
Document
payments to
project
participants
Document
economic
diversification
process
Tertiary control
Secure dispersal of
project revenues to
participants
Secure
implementation of
economic
diversification
projects
Secondary control
Provide advice on
payments to
project
participants
Provide advice on
economic
diversification
projects
Secondary control
Evaluate project
participants
involvement;
Discuss
recommendations
Primary control
Evaluate each
project phase;
Evaluate
Integrated Control
System;
Generate overall
recommendations
Tertiary control
Evaluate
involvement in
project;
Generate securityrelated
recommendations
Secondary control
Evaluate economic
impact of project;
Generate
recommendations
40
June 2007
Part A2
41
June 2007
42
A2
June 2007
Summary
The local production of finished poppy-based medicines in Poppy for Medicine
project villages would represent for project participants an increase in the villages
total revenue, and a move up the poppy value chain. This makes the business model of
the Poppy for Medicine projects essentially different from both the illegal and the
Indian legal opium systems, in which the farmers sell raw opium at the farm gate,
having added very little added value. The local production of medicines under a
licensed Poppy for Medicines project would ensure that Afghan farming communities
truly benefit from the mark-up between the production costs and retail prices of
morphine.
Figure 1: Price mark-up between raw poppy materials and finished medicines
4500
USD per kg
4000
of opium
equvalent 3500
3000
2500
Price mark-up:
+4000%
2000
1500
1000
500
0
Illegal opium farm gate Morphine retail price in

price in Afghanistan
Latin America
43
June 2007
The local processing of raw poppy material into finished poppy-based medicines such
as morphine would bring enough additional value to farming communities to provide
incentives for these communities to switch from illegal cultivation to participation in a
Poppy for Medicine project. Moreover, the significant economic benefits generated by
the local production and sale of medicines would be sufficient to accommodate all
local stakeholders, including middle-men and local power-holders. In conjunction
with law enforcement efforts, economic independence would allow farmers to cut
their links with major drug traffickers.
Redistributing the profits from sales of medicines in ways similar to those used in fair
trade initiatives, the business model of the Poppy for Medicines project is
economically viable. Afghan village based projects could provide reliable poppybased medicines to emerging countries well below their current market price, thus
contributing to an easing of the global pain crisis.
Poppy for Medicine projects are the key to surpassing Afghanistans reliance on
illegal poppy cultivation. The sales of locally-produced medicines would generate
significant revenues, enabling economic development through direct investment and
microfinance services. The local production of morphine medicines would also
benefit the Afghan government, enhancing its capacity to strengthen the rule of law
and provide public services, further improving the economic climate. In turn,
economic diversification and expansion would ultimately make possible the
sustainable phasing out of poppy cultivation.
44
1.
June 2007
The economics of Poppy for Medicine Projects: production and

sale of medicines
In a country where forty percent of the population is unemployed and Gross Domestic
Product stands at just USD 335 per capita,33 increasing the availability of sustainable,
legal incomes remains a key factor in enhancing rural communities access to
economic opportunities beyond subsistence farming.
1.1
Cash benefits accrued through Poppy for Medicine projects competitive

with illegal Afghan opium market
By leveraging Afghan farming communities existing assets of strong social control

and poppy farming expertise to locally produce simple poppy-based medicines such
as morphine, Poppy for Medicine projects allow these communities to bring the
inherent potential value of poppy back to the village. Benefiting from the economic
mark-up between the production costs and retail prices of morphine (more than
4,000%), sales of these medicines to the Afghan government would result in cash
benefits that are competitive with those offered under both the current illegal market
for opium, and the standard daily labour rates in Afghanistan.34
Table 1: Net incomes of Poppy for Medicine project participants
Occupation
Current net incomes in

Afghanistan
USD
Poppy farmer (per season)

Poppy harvester (per day)
Security guard (per day)
Laboratory worker (per month)
AFN
Net incomes of P4M project

participants
USD
AFN
450
22,185
917
45,900
7.6
375
395
3-15
148-740
395
350
17,280
400
19,850
33
International Monetary Fund, Report for Afghanistan, Estimate for 2007, [online] Available at:
http://www.imf.org/external/pubs/ft/weo/2007/01/data/weorept.aspx?pr.x=40&pr.y=8&sy=2004&ey=2
008&scsm=1&ssd=1&sort=country&ds=.&br=1&c=512&s=NGDPDPC,PPPEX&grp=0&a=
34
In the illegal opium market, farmers net income from poppy represents just 15-30% of the so-called
farm-gate price. Further, current farm-gate prices, as reported in the United Nations Office for Drugs
and Crime Afghanistan Opium Surveys, are now decreasing again.
Farm gate price of raw poppy materials in Afghanistan, per kilogram
Year 1994 1995 1996 1997 1998 1999 2000 2001 2002
USD 30
23
24
34
33
40
28
301
250
2003
283
2004
92
2005
102
2006
94
45
1.2
June 2007
Afghan-made morphine would be sold internationally at affordable prices
The vast un-met need for painkilling medicines in most countries illustrates that a
guaranteed market exists for Afghan-made essential pain medicines.35 The cost of
producing morphine in Afghanistan would be low enough that the Afghan
government could sell the medicines to individual states at accessible prices, thereby
allowing those states to respond to their countrys un-met pain needs.36
Poppy for Medicine project clusters would sell their locally-produced morphine to the
Afghan government for USD 3,100 per kilo. These medicines would then need to be
packaged to meet the international regulatory requirements for the export of poppybased medicines. By selling the morphine to other states for USD 4,300 per kilo,37 the
Afghan government would not only recover these international compliance costs, it
would gain direct financial benefits from Poppy for Medicine projects.
Afghan National Pharma Company: International Morphine Traders

In support of Poppy for Medicine projects the Afghan government could establish a
corporate entity to facilitate its international trade in locally-produced medicines. A
state-owned pharmaceutical company could be made responsible for the purchase and
packaging of locally-produced morphine. After providing for certification and export
compliance requirements, this national pharmaceutical company could sell the Afghan
locally-produced morphine at profit to other states, thereby ensuring that the Afghan
government receives direct financial benefits from Poppy for Medicine projects.38
35
For an in-depth examination of the extent of this market, see Part B2.
The World Health Organisation has noted that patients access to essential painkilling medicines is
highly dependent on affordability. See Scholten, Willem, Access to Controlled Medications
Programme, World Health Organisation Briefing Note, March 2007.
37
The mark-up between the Afghan governments purchase and export sales price of the morphine
would cover special packaging costs and labelling requirements. Some states have particularly high
regulatory costs and taxes, which could nearly double the price of the Afghan-made morphine (for
example the cost of importing one kilo of Afghan-made morphine into Brazil would cost the Brazilian
government USD 7,700 per kilo). However, even with these high import costs, Afghan-made morphine
would still be able to be sold at affordable prices significantly below the market average.
38
For further discussion of the ways in which Afghan-made morphine would be sold on the
international market, see section B3 and B4.
36
46
June 2007
Bringing the value of poppy to the villages: Case study Poppy for
Medicine project
This case study provides a strictly hypothetical description of an individual villagebased Poppy for Medicine project, to shed light on the project model. Although all the
figures would need to be carefully reassessed for a smaller Pilot Project or larger
village project, nevertheless, the case study provides interesting insights and allows
conclusions to be drawn regarding the potential economic impact of a Poppy for
Medicine project.
In a hypothetical Poppy for Medicine project village, poppy would be cultivated on

twenty-five small licensed farms of 0.37 hectares, or two jeribs, each.39 Sown in
autumn, the crops would be ready for harvest by project field workers the following
spring. Comprising a total of 9.25 hectares, the twenty-five farms would together
yield a total of at least 340 kg of raw poppy materials over the three-week harvest
period. At the end of each day, the days harvest would be collected and brought to
the project villages storage facility, to be documented and tested for morphine
content.40 Throughout the harvest period, trained project workers would begin the
medicine production process by drying the raw poppy materials.41 This initial
transformation step would yield around 310 kg of semi-processed raw poppy
materials.
These semi-processed raw materials would then be securely transported to the wellequipped district processing facility and transformed into morphine by professional
pharmaceutical chemists, with the support of project participants trained as laboratory
workers.42 The morphine would then be further processed into 10 mg tablets at the
district processing facility.
39
In Afghanistan, a jerib is a standard land area unit corresponding to 0.185 hectares, or 1,850 square
metres. According to the United Nations Office for Drugs and Crime, the average Afghan poppy farm
is two jeribs, or 0.37 hectares in size.
40
Each farmers daily harvest would be weighed in front of him and kept in a separate labelled
container. The price ultimately paid to each farmer for his harvest will be calculated with regards to the
morphine content of his poppies.
41
Each batch would dry in the sun for 4-5 days. Drying trays would be kept at the storage facility at
night, and taken outside or on the roof for drying by day.
42
The entire process will comply with the principles of Good Manufacturing Practice as endorsed by
the WHO. Quality tests will be performed by qualified staff on the incoming raw poppy material and
throughout the process, along with purity tests. Quality control equipment will notably entail a thin
47
June 2007
In total, approximately 30 kg of morphine would be transformed in morphine tablets

in a single hypothetical Poppy for Medicine project,43 for a total production cost of
USD 76,000. More than two thirds of these costs would be recycled back into the
local economy. After further quality control tests, the finished medicines would then
be sold to the Afghan government for a total of USD 96,000, bringing the
hypothetical village project a net profit of USD 20,000 to invest in local economic
diversification projects.44
Figure 2: Local level costs and revenues

Cooperative's Benefit
(channeled into economic
diversification), 56
Farmer's net income, 67
Production costs: USD 224 per kg

Price: USD 280 per kg
Transport (to Kabul), 1
Tabletting costs, 18
Agricultural supplies, 5
Equipment, 1
Other processing costs, 9

Chemicals, 7
Labour (processing), 11
Security (processing), 10
Labour (harvest), 68
Transport (local), 3
Security (harvest), 25
USD per kg of raw poppy

materials
The locally produced morphine would be securely transported to Kabul, where the
Afghan government would prepare the medicines for international export, possibly
through a special state-owned Afghan National Pharma Company. The packaged and
layer chromatography system, high performance liquid chromatography equipment and a

spectrophotometer.
43
The cooperative association would retain ownership over its input throughout the processing at the
project medicine laboratory. After the sale of the medicines, each cooperative association would pay a
fee to the project medicine laboratory for its processing and trading services.
44
This does not include the payment made to farmers for their harvest. It is estimated that farmers
would receive an average of USD 140 per kg of raw poppy material provided, depending on the
morphine content.
48
June 2007
labelled medicines would then be exported at a price of USD 3,800 per kg of

morphine to a country with extensive morphine needs, such as Brazil.45
Transport and export costs to Brazil, including all taxes and duties, can represent as
much as 80% of the value of finished morphine based medicines. However, medicines
imported for a Brazilian public institution are exempted of most of the import duties.
A conservative assumption that the full range of costs and taxes apply brings the price
of Afghan made medicine morphine exported to Brazil to USD 7,700 per kg, or USD
7.7 per gram. After including distribution costs, it is likely that one gram of Afghanmade morphine would cost the Brazil government less than USD 10 [representing a
hundred 10 mg doses], well below the Brazilian market price of USD 49.5. A Poppy
for Medicine project would provide affordable medicines to guaranteed markets, and
in doing so, would help to respond to a largely un-met need.
45
The finished and packaged medicines would be checked in accordance with the rules of Good
Manufacturing Practice and would match the international quality requirements.
49
June 2007
USD
per kg
6,000.0
2,000.0
1,800.0
1,600.0
1,400.0
1,200.0
1,000.0
800.0
600.0
400.0
200.0
0.0
Illegal Afghan Heroin
Value chain comparisons
Legal morphine made from

indian raw poppy material
USD per kg of raw poppy materials
Poppy for Medicine village

produced morphine
International retail
price
Country level
added
value
Local added value
Farmer's net income
50
2.
June 2007
The economic vehicle of Poppy for Medicine projects:

cooperative associations
As explained in Part A1 describing the Integrated Control System, for economic,

security, and sociological reasons, individual Poppy for Medicine projects should be
implemented in Afghan villages, with several individual projects clustered together in
a single district.
2.1
Cooperative medicine production systems most efficient model for Afghan

village-level Poppy for Medicine projects
In rural Afghan villages, the most economically efficient way of producing medicines
would be to group the communitys relevant resources in a cooperative model.
Cooperative production systems allow for the pooling of human and agricultural
resources for the collective purchase of additional inputs necessary to produce valueadded products, and for the fair redistribution of the profits on the sales of these
products. 46
2.2
How would a cooperative association work in a Poppy for Medicine

project?
During the planning phase of a Poppy for Medicine project, a village shura would
establish a cooperative association as a formal business entity, its membership
comprising all active project participants.47 This cooperative association would
provide both a formal structure through which a communitys human and agricultural
resources could be pooled to enable the production of added-value poppy-based
medicines, as well as a transparent means of recycling profits from medicine sales
into economic diversification activities to benefit the wider community.
As a locally owned and operated entity, the cooperative association would be

regulated and controlled by the project village shura. In exercising social control of
Poppy for Medicine project participants, the shura would effectively underwrite the
46
Around the world, producers associations and farmers cooperatives are used to manufacture valueadded agricultural products. Such value-adding cooperative models have proved to be successful both
in developed countries - wine cooperatives in France - and in transitional economies, for example dairy
cooperatives in India, and wood carving handicraft cooperatives in Kenya.
47
See Part A1 section 3 for further discussion of this formal business entity.
51
June 2007
cooperative associations capacity to contribute to the secure local manufacturing of

poppy-based medicines. In turn, by facilitating the production and sale of medicines,
the cooperative association would bring significant value to the shura-governed
village, thereby providing sufficient incentives to the shura to exercise its social
control capacities over project participants, guaranteeing the villages collective
committed participation in the Poppy for Medicine projects.
Co-guaranteed local production of poppy-based medicines

Planning phase
Production
phase
Sale phase
Village Cooperative Association
Village shura
Receive licence to cultivate poppy

for the production of medicines from
the Afghan government
Engage project participants as
temporary employees of Village
Cooperative Association
Establish a payment system for
Establish fund for diversification
Develop plans for recycling revenues
from medicine sales into economic
diversification
Guarantee the Cooperative

Associations compliance with the
licence provisions48
Select villagers for engagement as
Purchase inputs necessary for

medicine production
Arrange and fund the necessary
training of project participants
Coordinate the local production of
poppy-based medicines
Coordinate sales of medicines to the
Afghan government
Receive payment for medicines
Distribute payments to project
participants
Channel remaining revenues into
fund for economic diversification
Diversification
phase
Fund community-level economic

diversification projects
Provide micro-finance to villagers for
individual economic diversification
projects
Decide on payment system for

project participants49
Develop economic diversification
plans
Decide on criteria for micro-loans
for individual economic
diversification
Supervise distribution of agricultural
inputs to project participants
Control and secure the medicine
production processes
Secure export process from village
to ensure full delivery of medicines
and thus full payment
Ensure project participants are fairly
paid according to the agreed
payment system;
Impose any necessary fines
Ensure all remaining revenue is
channelled into economic
diversification fund
Select community-level
diversification projects
Arrange co-guarantor relationships
between borrowers of micro-loans
During the implementation phase of a Poppy for Medicine project, the cooperative
association would receive a licence to coordinate the cultivation of poppy for the
48
The Afghan government makes legal provision for the possibility of licensing opium production. See
Islamic Republic of Afghanistan, Counter Narcotics Law, Article 7, paragraph 3, [online] Available
at: http://www.mcn.gov.af/eng/downloads/documents/drug_law.pdf.
49
For further discussion of this, see section A1, section 3.3
52
June 2007
production of medicines. The cooperative association would then engage shuraselected project participants, and would purchase project farmers poppy harvests
through systems similar to those employed in French wine cooperatives.50 The
cooperative association would arrange for the local production of medicines from the
village-produced poppy materials, for
sale to the Afghan government. The
cooperative
association
would then
channel the revenues from medicines

sales back to the project participants and
into the community through shura-
Shura regulates the cooperative association

As the primary institution of control in Poppy for
Medicine projects, a project villages shura
would provide regulatory guidance to the local
cooperative association. This would facilitate
transparency, providing a further layer of security
to ensure revenues from the projects are properly
channelled into economic diversification. The
shura would identify and fund specific projects
which would benefit the economic diversification
activities of the community as a whole.
approved economic diversification plans

and projects.
2.3
Cooperative
association
provides
economic
infrastructure
for
diversification, and a conduit for international development assistance

In controlling the revenues from sales of locally produced medicines on behalf of
project participants, a cooperative association would provide the economic
infrastructure necessary to fund the controlled diversification of a project
communitys economic activities. To maximise the economic impact of Poppy for
Medicine projects, international development experts would assist the cooperative
association in the development of plans and models for economic diversification.
Further, through the project cooperative association, representatives and experts from
the
international
communitys
development agencies would provide

the
necessary
training
of
project
participants to enable the production of
P4M Benefit: Economic Infrastructure

The establishment of a cooperative association
would provide Poppy for Medicine project
communities with a locally owned and operated
formal economic infrastructure through which
future businessrelated activities can be
developed and enhanced.
medicines.
50
The cooperative association would purchase crops directly from the project farmers, who would then
pay their sub-contracted local harvesters. These sub-contractor harvesters would need to be approved
by the shura, to maintain local shura control of project participants, and may be project farmers family
members.
53
June 2007
Summary: Economic development through local production of poppy-based

medicines
Planning
phase
Village shura
Village
Cooperative
Association
District
processing
facility
Afghan
government
representatives
Guarantee the
Cooperative
Associations
compliance with
the license
provisions
Receive license
to cultivate
poppy for the
production of
medicines from
the Afghan
government
Receive
license to
manufacture
medicines
Provide licenses to
village cooperative
association and to
district processing
facility
Select villagers for

engagement as
Engage project
participants as
temporary
employees
Engage
laboratory
workers
Document project
participants
Decide on payment
system for project
participants
Establish a
payment
system for
project
participants
Establish fund
for economic
diversification
Develop plans
for recycling
revenues from
medicine sales
into economic
diversification
Purchase inputs
necessary for
agricultural
production
Develop economic
diversification
plans
Decide on criteria
for micro-loans for
individual
economic
diversification
Production
phase
Supervise
distribution of
agricultural inputs
to project
participants
Control and secure

the medicine
production
processes
Sales and
delivery
phase
Arrange and
fund the
training of
project
participants
Test and dries
raw poppy
materials
Secure export
process from
village to ensure
full delivery of
harvest and thus
full payment
Ensure project
participants are
fairly paid
according to the
agreed payment
system;
Impose any
necessary fines
Ensure all
remaining revenue
is channelled into
economic
diversification fund
Conclude special
trade agreements
with foreign states
Provide advice
on payment
systems
Provide advice
to shura on
economic
development
and
diversification
plans
Purchase
inputs
necessary for
medicine
production
Provide
training to
tablet
making
workers
Produce
poppy-based
medicines
Arrange
sales of
medicines to
the Afghan
government
Compensate
farmers and
other project
participants for
their input
International
development
Agency experts
Document
medicine
production
Provide
additional
medicine
production
training
Provide quality
control in
medicine
production
process
Purchase locallyproduced
medicines
Package medicines
for resale to
foreign states
Receive
payment for
medicines
Distribute
payments to
village
cooperative
associations
Channel
remaining
revenues into
fund for
economic
diversification
54
Diversification
phase
Select communitylevel diversification

projects
Arrange coguarantor
relationships
between borrowers
of micro-loans
Fund
communitylevel economic
diversification
projects
Provide microfinance to
villagers for
individual
economic
diversification
projects
June 2007
Provide advice
to shura on
implementation
of communitylevel projects
Provide advice
to villagers on
individual
diversification
projects
55
3.
June 2007
Economic Diversification through Poppy for Medicine projects
A diversified local economy is the key to longer term, sustainable development and
lasting security in Afghanistan. Currently, illegal poppy cultivation is a necessity for
many farmers, not a choice: farmers are exposed to risks most would never willingly
undertake, if given viable economic alternatives. As such, progressive economic
diversification is ultimately in the interest of Afghan farming communities,
representing an opportunity to move into less risky and more lucrative economic
activities. A cornerstone of the Poppy for Medicine projects initiative is ensuring that
this economic diversification takes place.
3.1
Compulsory Economic Diversification a key element in Poppy for

Medicine counter-narcotics model
Poppy for Medicine projects would help to end Afghan farming communities reliance
on illegal poppy cultivation, by providing them with access to the strategic assets
necessary to sustainably diversify their economic activities. The strategic assets to
which Poppy for Medicine project communities would have access include
competitive legal incomes from employment as project participants; expert
development advice from the representatives of international development agencies
included in the projects Integrated Control System; and the economic infrastructure
established by the projects cooperative association. This economic infrastructure
would include a fund for economic diversification, established during the project
planning phase.
These strategic assets would provide

project
communities
with
two
complementary routes to phasing out their

reliance on poppy: direct investment in
community-level development projects;
and indirect investment in individual
community
members
diversification activities.
economic
A community development project

One of the most important principles in the
increasingly important concept of fair trade is
the use of part of the profits from fairly traded
goods for the improvement of the local socioeconomic situation. By making Afghan-made
morphine available to foreign states at
accessible prices, and by providing for the
funding of projects that improve the project
communitys socio-economic situation, Poppy
for Medicine projects share a number of
similarities with other fair trade community
development projects.
56
June 2007
Direct investment in community-level diversification projects

During the planning phase of a Poppy for Medicine project, the shura would allocate a
proportion of the future revenues from sales of locally-produced medicines to be
channelled into development projects for the benefit of the entire village.51 During the
diversification phase of the project, the shura would fund community-level projects to
facilitate the diversification of the communitys business opportunities. For example,
the shura could use the diversification fund to invest in a pump to improve irrigation
to the whole village, allowing locals to begin cultivating more water-intensive crops.
The shura could also invest in the development of non-agricultural industries, or even
in infrastructure that would enable the addition of value to other locally-produced
agricultural products.
Microcredit for individual economic diversification activities

As well funding community-level diversification-enabling projects, the project
diversification fund would be used to grant small microcredit loans to finance
individual villagers efforts to diversify their economic activities. Microfinance is a
sustainable and cost-effective way for Poppy for Medicine projects to fund local
entrepreneurial initiatives to increase local prosperity and economic diversity.52 To
access microcredit from the economic diversification fund, entrepreneurs would need
to
first
establish
relationship
with
co-guarantor
another
village
member, and then prove to the shura

their capacity to successfully develop
their new economic activity, and to
P4M project micro-credit criteria

Microcredit is an efficient development tool when
used by those who have identified an economic
opportunity and simply need access to a small
amount of cash to be able to capitalise on that
opportunity.
repay their debt.
51
See Part A1, section 3.3 for further discussion of this.

In particular, microcredit - the granting of very small loans to people lacking access to mainstream
banking facilities enables economic diversification by facilitating the establishment of small incomegenerating non-agricultural businesses.
52
57
June 2007
58
June 2007
Part A3
Merits of Poppy for Medicine project as an integrated
counter-narcotics and counter-insurgency model
59
June 2007
60
A3
June 2007
Merits of Poppy for Medicine project as an integrated

counter-narcotics and counter-insurgency model
Summary
Poppy for Medicine projects would promote loyalty to the Afghan government and
entrench the rule of law in Afghanistan
Poppy for Medicine projects represent a comprehensive, secure, and pragmatic
economic development-orientated response to Afghanistans opium and security
crises. As a counter-narcotics model, Poppy for Medicine projects would entrench the
rule of law in Afghanistan, and in doing so, enable the Afghan government to extend
its capacity to control the rural parts of the country. As a counter-insurgency model,
the integration of the capacities of national and international-level security actors with
village control systems in the control and security of Poppy for Medicine projects,
would complement and enhance current efforts to counter the insurgency and stabilise
Afghanistan.
Illegal opium trade defeated through Poppy for Medicine-triggered development

Village-based Poppy for Medicine projects would enable Afghanistan to defeat the
illegal opium trade. Guaranteed to trigger economic development, Poppy for Medicine
projects would provide rural farming communities with access to the strategic assets
necessary to diversify their economic activities and thus end their reliance on illegal
poppy cultivation. Poppy for Medicine projects would not only allow for the
controlled, sustainable phasing out of poppy cultivation, they would generate
sufficient incentives for farming communities to cut links with drug traffickers.
Interdiction and eradication would thereby be brought to a manageable level, by
allowing distinctions to be made between the behaviour of those who cultivate poppy
as a survival strategy, and the truly criminal behaviour of drug traffickers.
61
June 2007
Poppy for Medicine: an anti-corruption counter-narcotics initiative

The Poppy for Medicine project model is designed to respond to the threat of
corruption associated with current eradication-based counter-narcotics efforts:
integrated local, national and international security resources would be concentrated
and targeted during the project phases most vulnerable to corruption. Further,
anchored in Afghan villages, Poppy for Medicine projects would operate at the most
securable and controllable - and least corrupt - level of Afghan society, where the
villages communitys capacity to socially control the behaviour of its inhabitants,
combined with the communitys common interest in the economic benefits of the
project, would preclude local corruption by project participants.
Countering narcotics by bridging security and development efforts

As a counter-narcotics model, Poppy for Medicine projects would bridge current
efforts to bring sustainable security and development in Afghanistan. Immediately
generating employment, legal incomes and providing access to strategic economic
assets, Poppy for Medicine projects would provide Afghan communities with both a
vision of a viable, positive future worth actively rejecting insecurity for, and the
means to achieve this future.
62
June 2007
Entrenching the rule of law and enhancing loyalty to the

Afghan government
1.1
Integrated control system provides total security of Poppy for Medicine

projects in all circumstances
Premised on the linking and maximising of Afghanistans existing security and

control resources to rein-in illegal poppy cultivation, village-based Poppy for
Medicine projects would be a comprehensive, secure and pragmatic counter-narcotics
response to the countrys illegal opium crisis. The existing strong social control
systems in Afghan villages are a vital institutional resource for the containment and
reduction of illegal poppy cultivation. In the control of a Poppy for Medicine project,
the integration of external controls with village-based controls would maximise the
efficacy of this vital institutional resource.53
1.2
Integration of local controls with external security support would build

collaborative relationships between rural communities and the ANA
The key benefit of locating Poppy for Medicine projects in Afghan villages is that
local and external control and monitoring resources would be concentrated and
targeted during the projects most critical phases, allowing for complete and total
security at all times. Further, by facilitating the construction of working relationships
between rural farming communities and the Afghan National Army, the integrated
control of Poppy for Medicine projects would complement and enhance current efforts
to secure and stabilise Afghanistan, by vividly demonstrating the willingness of
international security actors working in Afghanistan to win the hearts and minds of
Afghan farming communities.
1.3
Poppy for Medicine projects would entrench and enrich the rule of law in
Afghanistan
The Integrated Control System used to secure Poppy for Medicine projects would
entrench and enrich the rule of law in rural Afghan communities, by enmeshing
53
Based on proven local control systems as documented in extensive sociological and criminological
field research, the village-based Poppy for Medicine model can be easily adapted to the specific
circumstances of different villages in the different regions of Afghanistan where Poppy for Medicine is
most needed.
63
June 2007
existing local principles and measures of social control with the formal rules and
regulations administered by Afghan government representatives for the control of the
licensed cultivation of poppy and local transformation of medicine.
1.4
Afghan governments capacity to control and secure the country

enhanced through Poppy for Medicine projects
Field research in Afghanistan indicates that the countrys rural farming communities
strongly agree with the Afghan government and the international community on the
need to bring illegal poppy cultivation under control. However, the current counternarcotics policies being pursued in Afghanistan do not necessarily take into account
or reflect the needs of the countrys farming communities. In comparison, Poppy for
Medicine projects would have a stabilising inkblot effect on relations between the
Afghan government and rural communities. The integrated ways in which Poppy for
Medicine projects would be secured and controlled, would provide the opportunity for
Afghanistans rural farming communities to forge positive, collaborative relationships
with the formal institutions of the Afghan central government, as well as with the
representatives of the international community currently working to bring sustainable
security to Afghanistan.
1.5
Poppy for Medicine projects would increase rural communities loyalty to

the Afghan government
Supported and overseen by the Afghan government, Poppy for Medicine projects
would allow rural farming communities to switch their loyalties from drug
traffickers to the Afghan government, without having to effectively choose to let their
families starve. The administrative oversight of Poppy for Medicine projects by
representatives of the Afghan central government would promote local confidence in
formal institutions of governance, by providing a positive reason for the Afghan
governments interaction with and presence within rural communities. Those villages
running Poppy for Medicine projects would serve as examples of positive interaction
between the central government and rural Afghanistan.
Given their strong ties to the local communities over which they hold power, the
inclusion of local power-holders in the Poppy for Medicine projects would not only
help secure the projects, but would also help to open a positive dialogue between local
64
June 2007
power-holders and the central Afghan government, necessary to extend state support
in, and control of rural Afghanistan.
65
2.
June 2007
Providing the resources and incentives necessary to phase out

reliance on poppy
2.1
Bringing interdiction and eradication targets to manageable levels, Poppy

for Medicine projects would enable Afghanistan to defeat the illegal
opium trade
Violence, corruption and crime are associated with the current illegal opium economy.
This economy has to be tackled through the use of targeted law enforcement aiming at
drug traffickers, salesmen and other middlemen and actors working in the illegal drug
trafficking chain. By inducing rural farming communities to cut their links with
insurgents and drug traffickers, village-based Poppy for Medicines projects would
facilitate the targeting of counter-narcotics resources at those who do not cultivate
poppy as a survival strategy.
2.2
Poppy for Medicine projects would generate sufficient incentives for

project communities to exclude spoilers
The local transformation of poppy into medicine would not only provide the means
for rural farming communities to cut their economic links with drug traffickers, it
would remove the raw poppy materials from farmers possession, thereby removing
the possibility of maintaining such links with drug traffickers, enabling these
communities to live within the law. Further, the revenues generated by Poppy for
Medicine projects would be extensive enough to not only provide sufficient economic
incentives for farming communities to exclude drug traffickers and insurgents, but
also allow sufficient room to incorporate the needs of all potential stakeholders in a
Poppy for Medicine project.
The local addition of value to raw poppy materials sharply differentiates Afghan
Poppy for Medicine projects from the Indian legal opium business model, under
which Indian farmers sell raw opium at the farm gate to the Indian government with
no added value. The benefits to project participants illustrated in the village-level
value chain for morphine also differentiate Poppy for Medicine projects from
Afghanistans illegal drug market, under which farmers sell their poppy harvests at
the farm gate to drug traders, having added only very little value by drying the crop.
66
2.3
June 2007
Embedded diversification measures ensure that reliance on poppy would

be phased out
By triggering the economic development necessary to decrease illegal poppy

cultivation in Afghanistan, Poppy for Medicine projects would provide rural farming
communities with access to the funds, development expertise, and economic
conditions necessary to phase out poppy cultivation. As well as creating employment
and building capacity in Afghanistans farming communities, Poppy for Medicine
projects would provide for the compulsory phasing out of poppy cultivation, even for
the production of medicines. The economic diversification measures embedded in the
Poppy for Medicine project model would provide farming communities with both an
access to the strategic assets necessary to end their reliance on poppy, and an
obligation to do so.
As described in Part A2 of this paper, the revenues from sales of locally-produced

medicines would be channelled into economic diversification, through the direct
funding of projects for the benefit of the entire community, and the indirect funding,
through micro-finance principles, of individual project participants efforts to
diversify their economic activities.
67
June 2007
Foiling the corruption associated with counter-narcotics efforts
3.1
Local ownership of Poppy for Medicine projects prevents corruption
Linked to perceptions of inequity and poverty, corruption has had a severely negative
impact on current eradication-based counter-narcotics efforts in Afghanistan. As a
counter-narcotics initiative, the Poppy for Medicine project model specifically
addresses the threat of corruption. Anchored in Afghan villages, Poppy for Medicine
projects would operate at the most securable and controllable - and least corrupt level of Afghan society: where a villages capacity to socially control the behaviour of
its inhabitants, combined with the villages common interest in the economic benefits
of the project, would preclude local corruption by project participants.
3.2
Positive collaborative relationships needed to prevent corruption
As outlined in Part A1 section 2 by facilitating the development of collaborative

relationships between the Afghan government and rural communities, the integration
of existing community-level social control measures and state-level institutions into
the process of securing Poppy for Medicine projects would strengthen the rule of law
and promote good governance. As a comprehensive and positive counter-narcotics
initiative based on the even-handed provision of sustainable alternative livelihoods to
Afghanistans farming communities, Poppy for Medicine projects would ensure
proper remuneration for all stakeholders, addressing the poverty and perception of
inequality that fosters corruption.
3.3
Targeted security and control resources secure projects during critical

phases
To completely preclude the corruption of a Poppy for Medicine project, the

integration of local and external control and security resources would be concentrated
and targeted during those project phases most vulnerable to corruption.
68
June 2007
Immediately bridging security and development in Afghanistan
4.1
Engage rural communities in the stabilisation and development of their

country
Field research has revealed that most farming communities want to be part of the legal
economy, without the pressure and constant threats of drug traffickers and warlords.
Poppy for Medicine projects would allow rural communities to not only envisage a
legal, stable and sustainable economic future worth actively rejecting insecurity for,
but also actually achieve this future.
4.2
Counter narcotics by bridging security and development efforts
In Afghanistan, poppy cultivation represents an important survival strategy for

millions in Afghanistans rural farming communities, providing a livelihood but not
much more: the majority of Afghanistans poppy farmers cultivate poppy out of need,
not greed. In forcibly removing Afghan farming communities main cash crop, current
forced eradication-based counter-narcotics efforts are contributing to insecurity in the
country, as rural communities turn to the Taliban and insurgents to protect their cash
crops, thereby compromising the Afghan government and international communitys
efforts to secure, stabilise, and develop Afghanistan.
It is clear that economic development is the key to successfully and sustainably

stabilising Afghanistan, and extensive field research has made it equally clear that
counter-narcotics policies in Afghanistan must reflect this. The problem is that
currently, the economic development necessary to end farming communities reliance
on poppy cultivation is precluded by the ongoing insecurity in Afghanistan. The
village-based Poppy for Medicine project is a counter-narcotics initiative which
allows for the circumvention of this catch-22 situation. As outlined in Part A.1, the
security measures embedded in the Poppy for Medicine project model would allow for
the immediate development of the economies of rural Afghan farming communities.
The secure development generated by Poppy for Medicine projects would in turn have
an immediate ink-blot effect on security and development, and in doing so provide a
bridge to longer term sustainable security and development.
69
June 2007
70
June 2007
Part A4
Scientific Pilot Projects
71
June 2007
72
June 2007
Part A4: Scientific Pilot Projects
Summary
Following the release of this Technical Dossier, the next step is to implement
scientific Pilot Projects in different villages in Afghanistan to further test the
conditions and specifics of the Poppy for Medicine project. ICOS urges the Afghan
government and the international community to implement these scientific Pilot
Projects at the next planting season, commencing autumn 2007. This would allow for
an evaluation period from October to May to investigate, in carefully selected
villages, the essential agricultural, pharmaceutical, economic and control elements of
a Poppy for Medicine project.
73
June 2007
74
Control and Legal Framework
1.1
Control Framework
June 2007
The scientific Pilot Projects would test the comprehensive Integrated Social Control
system described in Part A1. The existing strong social control systems in Afghan
villages should be incorporated in the Pilot Project phase to examine the extent to
which village-based controls are able to safeguard against diversion of raw materials
and other illegal activities surrounding the Poppy for Medicine project.
1.2
Legal Framework
Poppy for Medicine projects, and the establishment of scientific Pilot Projects are
compatible with the Afghan Constitution, with Afghan domestic law and with the
international law related to drug control. The 2005 Afghan Counter Narcotics Law
contains extensive provisions for the distribution of licences to poppy farmers and
offers a strong basis for scientific Pilot Projects.54 Under the provisions of the treaties
governing the production of medicines from opium, no formal approval is required
from the International Narcotics Control Board. In accordance with international law,
without requiring any authorisation from or notification to an international body,
Afghanistan can immediately start cultivating poppy under a strict licensing system
for its own domestic use for the domestic manufacture of morphine.55 This is the case
regardless of whether the morphine is produced for domestic use or for export.
54
The Islamic Government of Afghanistan, Law on the classification of drugs and precursors,
regulation of licit activities and drug-related offences, December 2005, Article 7.
55
Brice de Ruyver and Laurens Van Puyenbroeck, The United Nations Convention Regime in The
ICOS, Feasibility Study on Opium Licensing in Afghanistan for the Production of Morphine and other
Essential Medicines (September 2005) [online] Available at:
http://www.icosgroup.net/modules/reports/Afghanistan_Opium_Licensing_Feasibility_Study
75
June 2007
2.
Timeline, Planning and Implementation
2.1
Timeline of the Pilot Poppy for Medicine project
The total running time of the Pilot Projects would be 8-9 months, or one growing
season, from October 2007 until May 2008. The exact running time would depend on
the planting and harvest seasons in the different provinces within which the Pilot
Projects would be implemented. For example, in Nangarhar province (eastern
Afghanistan), the poppy planting season starts in October and last until April, May.
One month before the start of the growing season, the pilot project site should be fully
operational and secured by the local community with help from the ANP. This means
that the organization of the Pilot Projects should start in August 2007.
Pre-planning
Planning
Implementation
Evaluation
August 2007
September 2007
Oct./Nov. 2007
May/June 2008
2.2
Implementation of the Pilot Poppy for Medicine Projects
A Pilot Poppy for Medicine Project would comprise a planning phase, five
documentation phases and an evaluation phase:
I.
Planning phase
Meet the stakeholders and community leaders at the level of the local institutions and
discuss the basic outline of the Pilot Project
II.
Documentation phase I: Implementation:
Document the proceedings at the informal local decision-making shura which is

setting up the small Pilot Cooperative. At this stage, the members of the cooperative
are selected (farmers), and the sub-contracted land-labourers, local guards, carriers,
lab staff and other staff that is needed. The lands are selected and the best
arrangements for agricultural inputs (seeds, fertiliser, etc.) are agreed upon; While a
preliminary budget and inventory lists should be drawn up before the implementation
phase, the initial work of the shura and the discussions with the Pilot Cooperative
76
June 2007
members would reveal whether these are realistic in terms of costs and necessary
inputs;
III. Documentation phase II: Cultivation

Documentation during the growing season: During the months prior to the harvest, the
implementation and running phase of the Pilot Project should be documented
carefully to allow for a thorough evaluation of the different pilots in different areas;
IV. Documentation phase III: Harvesting

Documentation and external monitoring during the harvest period: This includes
monitoring of the harvesting methods and yield per farmer and per Pilot Cooperative
and checking the total yield of the Cooperative against the area of poppies originally
planted and the quantity of poppies harvested.
V.
Documentation phase IV: Medicine production:
Documentation of how the raw poppy materials would be converted in the small
laboratories of the Pilot Project sites, and how they would be packaged.
VI. Documentation phase V: Sales and delivery:

Documentation of how the medicines would be transported to Kabul for domestic
distribution, and how they would be exported and sold to international markets.
VII.
Evaluation phase
Evaluation of the whole Pilot Project, from planning, to the delivery of the medicines.
77
Number and Location of Pilot Projects
3.1
Number of Pilot Projects
June 2007
For a proper evaluation and comparison of different Pilot Projects, a minimum

number of three Pilot Projects is suggested. This would allow for the testing of
different climatic and agricultural conditions, and different local decision-making and
control processes.
3.2
Location of the Pilot Projects
The location of the scientific Pilot Projects should be carefully selected. If three areas
can be selected, these could be located in the northern, eastern and southern part of the
country. If more than three Pilot Projects test farms are possible, it might be possible
to have a cluster of a number of test farms in each area.
The Pilot Project in the southern part of the country should not be situated in a
fighting zone, or anywhere fighting has taken place over the past six months. Instead,
the selected location should be an area under the control of local district officials,
rather than the Taliban or insurgents.
Other selection criteria are:

1. The villages that are selected should have strong local cohesion;
2. They should be located in the main opium growing areas;
3. They should have at least some experience with cultivating poppy;
4. The Pilot Project village should be close enough to a city to allow regular
inspections by national and international supervisors and security forces.
78
Employment
4.1
Number of people involved in the Pilot Project
June 2007
There would be 5 farms in each Pilot Projects. The area of the Pilot Project would be
approximately two hectares. For each farm, the family of the farmer would cultivate
the poppies, if necessary assisted by sub-contracted land labourers. To harvest the
poppies, a total of six harvesters are needed per farm amounting to a total of 30 for the
whole Pilot Projects. During harvesting and processing, there would be twelve
security guards for the laboratory and 10 security guards for the whole Project (two
per farm). In the laboratory, an estimated number of ten laboratory staff would be
working. Two drivers are assigned to transport the opium from the fields to the lab on
a daily basis during harvest times. Four guards from the lab would accompany them.
For final transportation to Kabul, a selection of guards and drivers already employed
by the Pilot Projects would be allocated. Total employment during cultivation
would amount to between 50-60 people. During harvest time, the total
employment would increase up to 100-110 people.
79
June 2007
80
June 2007
Part B
Afghan-made medicines
to meet the global need for painkillers
81
June 2007
82
June 2007
Part B1
The global supply, use, and need for
essential poppy-based medicines
83
June 2007
84
B1
June 2007
The global supply, use, and need for essential poppy-based

medicines
Summary
Poppy-based medicines such as morphine play a fundamental role in the treatment of
pain, and the overall worldwide need for adequate and sustained pain relief is
increasing. Research shows that in more than 150 countries, containing about 80% of
the worlds population, only a tiny minority of the patients in need of morphine
treatment actually receives this morphine.56 Millions of people, particularly cancer
and HIV/AIDS sufferers in emerging countries, live and die in unnecessary pain
because their needs for essential morphine medicines are not being met.
56
World Health Organisation, Briefing Note: Access to Controlled Medications Programme, March
2007, p.1; World Health Organisation, Access to Controlled Medications Programme: Framework,
February 2007, p.6.
85
June 2007
86
June 2007
Demand and supply: the current poppy-based medicines

production system
1.1
Principles of the current system
The production, international trade and use of poppy-based medicines such as

morphine are strictly controlled under international law through an elaborate system
of estimates and statistical returns.
The 1961 Single Convention on Narcotic Drugs governs the annual international trade
of opiates raw materials used for scientific and medical purposes. Adherence to the
rules and regulations of this Convention is overseen by the International Narcotics
Control Board (INCB). National governments must submit to the INCB quarterly and
annual statistical reports on the manufacture, use, import and export of poppy-based
medicines to ensure that the worldwide supply of these medicines does not greatly
exceed demand, nor fall significantly below the prescribed targets. As such, the
international supply of raw materials used to make morphine depends almost entirely
on the estimated global demand for these raw materials, as measured through the
INCB-administered system.
Providing for the strict control of the raw poppy materials used in the production of
medicines, this system can be described as an almost perfect closed, planned
economy. Importantly, under article 21 of the 1961 Single Convention on Narcotic
Drugs, the quantity of essential opium-based medicines manufactured in, or imported
into, a country must never exceed the official estimate which that country had
submitted to the INCB. These statistical reports constitute a countrys official
requirements of narcotic drugs for the following year; once validated by the INCB,
the estimates become binding for governments. Supply countries57 are only legally
allowed to produce as much as is necessary to meet the total estimated global
requirements. Thus the availability of morphine around the world in any one year is in
effect dependent on the total use of primary materials from two years previous.
57
Supply countries are those countries which supply poppy raw materials and/or manufacture poppybased medicines. The major supply countries are India, Turkey, Australia, France, Spain and the UK.
87
1.2
June 2007
Stocks within the system
Although significant stocks of raw poppy materials currently exist in several

countries,58 these stocks do not represent a global over-supply. Stocks appear within
the current poppy-based medicine supply system for two main reasons:
1. Because INCB-administered commodities constitute the raw materials for a range
of essential medicines, consumer countries often build up strategic reserves to be
able to cope with future shortage;
2. Producing countries build stocks to both smooth price trends over time, and to
compete effectively with other producing countries.
Typically, stocks of agricultural commodities are at levels sufficient to cover several
years of consumption. In comparison, current stocks of raw poppy materials are
relatively low.59 Moreover, because these stocks are created and managed within the
current supply system, they can not be used to supply needs un-accounted for by the
INCB-administered system.
1.3
Current system provides for market demand, not actual need
The INCB administered system is designed to identify market demand for raw poppy
materials and to manage the related supply. The INCB has proven efficient
administrating this highly regulated market. It does not, however, state the actual need
for poppy-based medicines.
In emerging and transitional countries, patients demands for morphine and other
poppy-based medicines are currently significantly underestimated because of a selfperpetuating cycle of medical under-prescription and restrictive regulations which
inhibit countries ability to import morphine. Given that demand is measured - under
the current supply system - by actual consumption the previous year, demand from
less economically developed nations remains structurally low and systematically
58
For instance, the United States, France and Japan hold important stocks of raw poppy materials: for
opium, the US has stocks of 95 tons, France 11.9 tons and Japan 144 tons. India keeps the largest
stocks with 1632 tons. See: International Narcotics Control Board, Estimated World Requirements for
2007, Statistics for 2005, Part 4: Statistical Information on Narcotic Drugs, Table XII, p. 79 [online].
Available at: http://www.incb.org/pdf/e/tr/nar/2006/Narcotics_publication_2006_part4_en.pdf
59
See: International Narcotics Control Board, Estimated World Requirements for 2007, Statistics for
2005, Part 4: Statistical Information on Narcotic Drugs, Table XII, p. 73-81 [online]. Available at:
http://www.incb.org/pdf/e/tr/nar/2006/Narcotics_publication_2006_part4_en.pdf
88
June 2007
understates the actual need. As such, many countries, most of the less economically
developed and emerging countries, but also even highly industrialised countries, are
caught in a cycle that deprives patients of the essential medicines necessary to ease
the global pain crisis. Furthermore, in a number of countries the system to assess and
submit estimates to INCB does not function well
Un-met need for painkillers in Latin America

The consumption of poppy-based medicines in Latin America is extremely low,
despite its large population and increasing cancer and HIV/AIDS burdens. Latin
America consumes less than 1% of the global consumption of morphine, due to
under-prescription by medical staff untrained in poppy-based medicines, overly
restricted laws and the high cost. Most countries are below the global mean of 6.2 mg
of poppy-based medicines per capita, although some countries have increased. In
2005 the entire population of Argentina (39.9 million) used just 96 kg of morphine,
what represent 2.4 mg per capita. This only represents one tenth of the morphine
consumption per capita rate in Germany, which in 2005 was 24.5 mg.
Only 510% of patients in Latin America in need of palliative care receive it, and
97% of palliative care provision is available in large cities. In 2005, to meet the pain
needs of the end-stage HIV/AIDS and cancer patients in Latin America, 7.1 metric
tons of morphine would have been needed, but just 600 kg of morphine was actually
used, leaving 91% of these patients pain needs un-met.
Low estimates of a countrys demand for morphine are a result of a number of factors,
including doctors reluctance to prescribe medicines their patients will not be able to
actually purchase; the relatively high cost of these medicines; dysfunctional
bureaucracies that impose overly restrictive regulations which limit the number of
pharmacies that stock the medicines, thereby further limiting patients access to these
medicines
and
constraining
doctors
prescribing
practices;
and
cultural
misunderstandings related to the effects of poppy-based medicines.60 This in turn
60
International Narcotics Control Board Report 2000, Over-consumption of Internationally Controlled

Drugs p.2-3, [online] Available at:
http://www.incb.org/pdf/e/ar/2000/incb_report_2000_1.pdf.
89
June 2007
results in an inadequate supply of poppy-based medications, leaving countries such as

those in Latin America with a great disparity between need and supply (see box).61
For those countries whose bureaucracies and health system are able to identify and
supply a demand corresponding to the essential need of their population, the current
international system of supply functions adequately. Nevertheless, the INCB has
admitted that Most developing countries lack the resources and expertise required for
determining medical needs and adjusting drug supply to meet those needs.62 The
existence and perpetuation of an un-met need outside the market demand is an
alarming fact that calls for watchful analysis and swift action.
For further discussion of these factors, see Logie, D. E., and R. Harding, An evaluation of a morphine
public health programme for cancer and AIDS pain relief in Sub-Saharan Africa, BMC Public Health,
2005; 5: 82, [online] Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1232854
61
International Narcotics Control Board, Estimated World Requirements for 2007: Statistics for 2005,
Part 4: Statistical Information on Narcotic Drugs, [online]. Available at:
http://www.incb.org/pdf/e/tr/nar/2006/Narcotics_2006_ebook.pdf
See also: Wenk and Bertolino, Palliative Care Development in South America: a focus on Argentina,
Journal of Pain and Symptom Management, Vol. 33, No. 5, May 2007, p. 646-647
62
International Narcotics Control Board Report 2000, Over-consumption of Internationally Controlled
Drugs p.2-3, [online]. Available at:
http://www.incb.org/pdf/e/ar/2000/incb_report_2000_1.pdf.
For further discussion of these factors, see Logie, D. E., and R. Harding, An evaluation of a morphine
public health programme for cancer and AIDS pain relief in Sub-Saharan Africa, BMC Public Health,
2005; 5: 82, [online] Available at:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1232854
90
June 2007
The global un-met need for morphine
2.1
Official measurements of demand do not reflect actual morphine needs
The actual need for painkilling medicines worldwide is not fully matched by figures
measuring market demand. In particular, as most of the worlds population still has
little access to painkilling medicines, the actual need for morphine remains largely unmet.
Official figures from the INCB show that just a handful of wealthy countries consume
the significant majority of the global supply of poppy-based medicines. For instance,
the United States, Canada, Europe, Japan, Australia and New Zealand, together
representing less than 20% of the worlds population, accounted for more than 95% of
the total morphine consumption in 2005.63 This indicates a significant underconsumption of morphine affecting the remaining 80% of the worlds population,
whose combined morphine consumption represented less than 5% of the global total.
WHO efforts to increase prescription of poppy-based medicines

Stressing the need for a balance between the obligations posed by UN conventions for
fighting against the illegal narcotics, and the need to ensure and, in most cases,
increase the availability of poppy-based medicines,64 the World Health Organisation
(WHO) heavily promotes the prescription of poppy-based medicines for the treatment
of pain, and includes morphine is on its list of essential medicines.65 Based on the
known effectiveness of morphine and codeine, the WHO has created a three step pain
ladder known as the WHO Analgesic Method for Cancer Pain Relief, designed to
provide a scientific basis to encourage health professionals worldwide to use poppy63
International Narcotics Control Board, Estimated World Requirements for 2007, Statistics for 2005,
Part 4: Statistical Information on Narcotic Drugs, Figure 13, p. 79 [online]. Available at:
64
World Health Organisation, Achieving Balance in National Opioids Control Policy, 2000, [online].
Available at: http://whqlibdoc.who.int/hq/2000/who_edm_qsm_2000.4.pdf Ibid. Guideline number 12
of the report states that governments should permit and encourage the distribution and availability of
opioid medications throughout the country, in order to maximize physical access of patients to pain
relief medications while maintaining adequate controls to prevent diversion and abuse.
65
Essential medicines, as defined by the World Health Organisation are "those drugs that satisfy the
health care needs of the majority of the population; they should therefore be available at all times in
adequate amounts and in appropriate dosage forms, at a price the community can afford." See: World
Health Organisation, s WHO Model List of Essential Medicines, 15th edition, March 2007, p.2
[online]. Available at: http://www.who.int/medicines/publications/EML15.pdf
91
June 2007
based medicines to treat pain.66 To help address the impediments that hamper the
availability and use of poppy-based medicines particularly in less economically
developed and emerging countries, at the request of the United Nations Economic
and Social Council COSOC and the World Health Assembly,67 the WHO developed
the Framework to the Access to Controlled Medications Programme in consultation
with the INCB.
Despite the World Health Organisations limited success in promoting poppy-based
medicines for palliative care for cancer and HIV/AIDS in emerging countries, the
sheer enormity of the global pain crisis demands ongoing sustained action by the
WHO, governments and international regulatory boards. Moreover, given the
increasing need for cancer and HIV/AIDS related palliative care, demand for poppybased medicines is set to rise dramatically in the next few years.68
2.2
Current per capita use of and global need for poppy-based medicines
Although the World Health Organisation has long acknowledged the existence of such
an extensive un-met need, measuring the size of the un-met need for morphine is
difficult. However, some measurements are available. A comparison of national per
capita uses of morphine reveals glaring discrepancies in the use of morphine within
individual countries, a reliable lower bound estimate of the amount needed can be
obtained by calculating the morphine need for HIV and cancer treatment.
International comparisons of per capita consumption levels allow a quick assessment

of the relative size of the global morphine shortage. An estimate of the global un-met
66
WHO has developed a three-step "ladder" for cancer pain relief: If pain occurs, there should be
prompt oral administration of drugs in the following order: non-opioids (aspirin and paracetamol); then,
as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of
pain. To calm fears and anxiety, additional drugs adjuvants should be used. To maintain freedom
from pain, drugs should be given by the clock, that is every 3-6 hours, rather than on demand This
three-step approach of administering the right drug in the right dose at the right time is inexpensive and
80-90% effective. Surgical intervention on appropriate nerves may provide further pain relief if drugs
are not wholly effective. World Health Organisation Pain Ladder, [online]. Available at:
http://www.who.int/cancer/palliative/painladder/en/
67
Resolutions ECOSOC 2005/25 and WHA58.22, 2005.
68
According to the WHO, the incident rates for cancer are expected to increase by 20% within the next
two decades.
92
June 2007
pain needs in a number of global regions can be calculated under any given
hypothesis on the required or attainable level of consumption.
This is done by calculating the quantities of morphine actually consumed per capita in
various global regions (see Table 2), and then calculating the quantities of morphine
needed to raise the per capita consumption rate of under-consuming regions to a given
higher proportion of the average rate of those regions in which patients pain needs
are largely being met (see Table 3).
Morphine consumption rate in most global regions does not reflect actual needs
In 2005, the average consumption of morphine was just 4.9 mg per person globally.
However, this global rate clearly does not reflect uniform actual consumption of
morphine around the world.
Table 2: Regional per capita use of morphine in 2005

Region
North America
Latin America
Western Europe
Eastern Europe & Central
Asia
Asia & Pacific
Northern Africa & Middle
East
Sub-Saharan Africa
Global
Population
(million)69
Total
(kg)70
morphine
use
Consumption per capita (mg)

71
331
549
387
495
18,402
573
9,296
681
55.50
1.04
24.02
1.37
3,620
350
2,431
103
0.67
0.29
741
6,473
228
31,700
0.30
4.90
Rather, the majority of the global morphine supply was consumed in North America
and in Western European countries, despite those regions accounting for just 17.2% of
the world population.72 The per capita consumption rates of these regions (55.5 mg for
North America and 24 mg for Western Europe) were significantly higher than the
69
All figures taken from United Nations 2005 Demographic Yearbook [online], Available at:
http://unstats.un.org/unsd/demographic/products/dyb/dyb2.htm
70
Part 4: Statistical Information on Narcotic Drugs, [online] Available at:
71
The per capita rate is calculated by dividing the total global morphine use by the total population.
72
Part 4: Statistical Information on Narcotic Drugs, Figure 13 p.79 [online] Available at:
93
June 2007
regional averages of Eastern Europe and Central Asia (1.4 mg), Latin America (1
mg), or Sub-Saharan Africa (0.3 mg).
2.3
Estimates
of
un-met
morphine
need
through
extrapolation
of
consumption needs
That the majority of the global populations morphine consumption rates are
significantly lower than that of Western Europe indicates an extensive gap between
the supplies of, and actual need for, essential poppy-based medicines. If patients
suffering from pain in other global regions73 were to have used as much morphine per
capita in 2005 as patients in Western Europe (24 mg), an extra 134 metric tons of
morphine, (representing 1341 metric tons of opium) would have been needed (see
figure 3 below).
Table 3: Increasing regional morphine consumption to Western Europe rates

Current
annual
consumption
per capita (mg)
Quantity of morphine
needed to increase
annual consumption to
12mg per capita (mt)
Quantity of
opium needed
to make this
morphine (mt)
Western Europe
55.50
1.04
24.02
6.0
-
60.1
-
12.6
-
126.0
-
Eastern Europe
& Central Asia
Asia &Pacific
1.37
0.67
5.3
41.0
52.6
410.1
11.2
84.4
112.0
844.5
0.29
4.1
41.0
8.3
83.0
0.30
4.90
8.7
65.0
86.6
650.4
17.6
134.1
175.6
1341.0
Region
North America
Latin America
Northern Africa
& Middle East
Sub-Saharan
Africa
World
Quantity of morphine
needed to increase
annual consumption to
24mg per capita (mt)
Quantity of
opium needed
to make this
morphine (mt)
For sub-Saharan Africa alone, 17.6 metric tons of morphine would be needed if
patients there were to consume morphine at the same rate as patients in Western
Europe.74 Moreover, because Sub-Saharan Africa bears the worlds largest HIV/AIDS
burden, the regions need for pain-medicines is likely to be significantly higher than
that in Western Europe.
73
The global regions referred to here are Latin America, Eastern Europe and Central Asia, Asia and
Pacific, North Africa and Middle East, and sub-Saharan Africa.
74
According to the WHO, the mortality rates for cancer in Africa are significantly higher than the
mortality rates in Europe, due to later detection times for incidences of cancer in African countries. Due
to the later detection of cancer in African countries, often the only form of treatment cancer patients
receive is palliative care. As such, the need for poppy-based painkillers is much higher in Africa than in
Europe.
94
June 2007
A further 84 metric tons of morphine, representing the equivalent of 844 metric tons
of opium, would have been needed, for all patients in Asia and Pacific to be able to
consume morphine at the same rate as patients in Western Europe in 2005. Even if
patients in Latin America, Eastern Europe and Central Asia, Asia and Pacific, North
Africa and Middle East, and sub-Saharan Africa had used just half as much morphine
as patients in Western Europe did in 2005, an extra 65 metric tons of morphine,
(representing 650 metric tons of opium) would have been needed.
2.4
Extensive morphine shortage for pain associated with cancer and

HIV/AIDS
A reliable estimate of a significant part of the global morphine shortage can be

calculated using measurements of the pain needs of end-stage cancer and HIV/AIDS
patients in the world. The un-met pain needs of specific sets of patients in a given
country can be reliably assessed through a method based on the use of morphine for
the treatment of pain. A disease-specific need for morphine can be calculated using
the prevalence or mortality rate linked to that disease and the corresponding treatment
average requirements.
The extent of the 2005 global shortage of pain-medicines for end-stage cancer and
HIV/AIDS can be measured using the calculations employed by researchers from the
University of Toronto.75 Estimates for various global regions and for the world are
75
See Figure 1 and Fischer, B J. Rehm, and T Culbert, Opium based medicines: a mapping of global
supply, demand and needs in Spivack D. (ed.) Feasibility Study on Opium Licensing in Afghanistan,
Kabul, 2005, p.66, [online]. Available at:
These patients pain needs are calculated from the number of cancer and HIV/AIDS deaths in 2005,
multiplied by the average length of treatment (180 days) at the average dosage level (120 mg per day).
According to medical literature the average length of time per patient spent in end-stage cancer is
approximately 6 months, or 180 days, and the average maintenance level of morphine given to patients
for cancer pain is 30 mg every 3 to 4 hours, or approximately 120 mg per day. Around 70% of end
stage cancer patients and 50% of end-stage HIV/AIDS patients endure moderate to severe pain. Given
that not all end-stage HIV/AIDS and cancer patients experience moderate to severe pain, or receive
treatment for their pain, this calculation is bound by the conservative assumption that at least half of the
total number of patients who died from HIV/AIDS in 2005, and 45% of those that died from cancer
that year received morphine treatment for their moderate to severe pain.
See den Daas, N. 1995, "Estimating Length of Survival in End-Stage Cancer: A Review of the
Literature", Journal of Pain and Symptom Management, vol. 10, no. 7, pp. 548-555; Hough, S. W. &
Portenoy, R. K. 2004, "Medical Management of Cancer Pain," in Principles and Practice of Pain
Medicine, 2 ed, C. A. Warfield & Z. H. Bajwa, eds., McGraw-Hill, pp. 465-476. The numbers of
deaths in 2005 from HIV/AIDS are taken from the 2006 UNAIDS Epidemic Update Report, December
2006, [online] Available at: http://data.unaids.org/pub/EpiReport/2006/2006_EpiUpdate_en.pdf; The
95
June 2007
shown in a table (Table 4). These results provide consistent lower bound
approximations of the overall need for poppy-based medicines.
In 2005 end-stage cancer and
Palliative care needs to increase in the future:
HIV/AIDS
Pain relief experts predict the global need for pain

medication will increase. By 2020, there will be a
significant ageing population in Europe, North
America, East Asia and Latin America. HIV/ AIDS
projections in 53 African countries suggest that
mortality due to HIV will increase by a factor of five,
while global cancer rates will increase by 50% from
10 million in 2002 to 15 million in 2010.
Furthermore, 50% of new cancer cases are now
occurring in developing countries.
patients
in
Eastern
Europe and Central Asia needed a

total
of
9.5
metric
tons
of
morphine; yet according to the

INCB,
the
total
quantity
of
morphine consumed in this region
that year amounted to less than 600 kg.76 Thus, a further 8.9 metric tons of morphine,
equivalent to 89 metric tons of opium, would have been needed. In other global
regions, the gap between the actual need and annual use is even wider. In Africa in
particular, the need for essential poppy-based pain medicines remains mostly un-met.
The 2 million people who died of HIV/AIDS and cancer in sub-Saharan Africa in
2005 consumed less than 1% of the quantity of morphine that was required (76.5
metric tons). Likewise, Asias need for poppy-based pain-killing medicines is far from
being met. In 2005, 98% of the pain needs of dying HIV/AIDS and cancer patients in
Asia were not met.
These figures show that significant levels of pain medicine needs are going un-met
around the world. Furthermore, it should be noted that the above figures only
represent the un-met needs of HIV/AIDS and cancer patients for morphine, while
other patients suffering from post-operative and chronic pain are not taken into
account. Thus it is likely that the pain-medicine deficits in these regions would be
even more alarming once all the poppy-based medicines needs of patients are factored
in. Equally, pain medicine needs are set to rise in the future, as palliative care
becomes more necessary.77
numbers of deaths from cancer are taken from the World Health Organisations online assessment tool
The Impact of Cancer by Country, [online] Available at:
http://www.who.int/ncd_surveillance/infobase/web/InfoBasePolicyMaker/reports/ReporterFullView.as
px?id=5
76
Part 4: Statistical Information on Narcotic Drugs, Table XII, pp.204-229 [online]. Available at:
77
Callaway, M. and Ferris, F., Foreword; Special Issue Advancing Palliative Care: the Public Health
Perspective, Journal of Pain and Symptom Management, Vol. 33, No. 5 May 2007, p. 484
96
June 2007
Table 4: Cancer and HIV/AIDS morphine needs in global regions in 2005

Region
Disease
Eastern
Europe
&
Central
Asia
Asia
HIV/AIDS
Cancer
HIV/AIDS
Cancer
HIV/AIDS
Cancer
HIV/AIDS
Cancer
HIV/AIDS
Cancer
Sub-Saharan
Africa
Latin
America
Global
Morphine
treatment
period80
(days)
Daily81
dosage
(mg)
Estimated
need82
(mt)
Actual
use83
(mt)
Unmet
need84
(mt)
Opium
need85
(mt)
53,000
780,000
Estimated
no. of
patients in
moderate
to severe
pain79
26,500
351,000
600
180
120
120
1.9
7.6
0.598
8.9
89
633,000
3,580,000
2,000,000
460,000
59,000
519,000
2,800,000
7,600,000
317,000
1,610,000
1,000,000
207,000
29,500
234,000
1,400,000
3,420,000
600
180
600
180
600
180
600
180
120
120
120
120
120
120
120
120
22.8
34.8
72.0
4.5
2.1
5.0
100.8
73.9
0.637
57.0
570
0.228
76.5
765
0.577
6.6
66
31.8
142.9
1429
No. of
deaths in
200578
78
The numbers of deaths due to AIDS in 2005 are taken from the 2006 UNAIDS Epidemic Update
Report, December 2006, [online]. Available at:
http://data.unaids.org/pub/EpiReport/2006/2006_EpiUpdate_en.pdf;
The numbers of deaths from cancer are taken from the World Health Organisations online assessment
tool The Impact of Cancer by Country, [online]. Available at:
http://www.who.int/ncd_surveillance/infobase/web/InfoBasePolicyMaker/reports/ReporterFullView.as
px?id=5
79
Given that not all end-stage HIV/AIDS and cancer patients experience moderate to severe pain, or
receive treatment for their pain, this calculation is bound by the conservative assumption that only half
of the total number of patients who died from HIV/AIDS in 2005, and 45% of those that died from
cancer that year would have received morphine treatment for moderate to severe pain.
See: Lefkowitz, M. & Breitbart, W. 1998, Chronic Pain Associated with Aids, Pain Management: A
Practical Guide for Clinicians, 5 ed, vol.2 R.S. Weiner, ed., St. Lucie Press, pp.541-614.
80 The average length of time per patient spent in end-stage cancer is approximately 6 months, or 180
days, while the average length of AIDS end-stage survival is 20 months, or approximately 600 days.
See: den Daas, N. 1995, "Estimating Length of Survival in End-Stage Cancer: A Review of the
Literature", Journal of Pain and Symptom Management, vol. 10, no. 7, pp. 548-555; Hough, S. W. &
Portenoy, R. K. 2004, "Medical Management of Cancer Pain," Principles and Practice of Pain
Medicine, 2 ed, C. A. Warfield & Z. H. Bajwa, eds., McGraw-Hill, pp. 465-476; Lefkowitz, M. &
Breitbart, W. 1998, Chronic Pain Associated with Aids, Pain Management: A Practical Guide for
Clinicians, 5 ed, vol.2 R.S. Weiner, ed., St. Lucie Press, pp.541-614.
81
According to medical literature (see above), the average maintenance level of morphine given to
patients for cancer and HIV/AIDS pain is 30 mg every 3 to 4 hours, or approximately 120 mg per day.
82
Disease-specific needs for morphine are calculated from the estimated number of cancer or
HIV/AIDS of patients in moderate to severe pain in 2005, multiplied by the average length of treatment
at the average dosage level.
83
The regional figures for actual use of morphine for the year 2005 were compiled using INCB data.
Table XII, pp. 204-229 [online]. Available at:
84
These estimates of the un-met need are obtained by subtracting actual consumption from the
combined morphine need for the treatment of HIV/AIDS and cancer.
85
This figure represents the equivalent in opium of the un-met need for morphine, assuming a
morphine to opium ratio of 1/10. Indeed, to produce 1 kg of morphine, around 10 kg of opium are
required.
97
June 2007
Afghan morphine needed to meet actual global need for painkillers

The global need for poppy-based medicines far outweighs their current availability.
Even in the worlds six richest countries, which include the United States and the
Western Europe, only 24% of patients pain needs are being met.86
In 2006, Afghanistan produced 6,100 metric tons of opium. Yet even this huge
quantity would be insufficient to meet the worlds current actual morphine needs,
which in 2005 were estimated to be equal to 6,152 metric tons of opium.87
The licensing of Afghan poppy crops would go a long way towards improving the
quality of life for those suffering severe pain, especially in transitional and emerging
countries where the availability of poppy-based medicines is at its lowest. The
potential market for the affordable medical morphine that Afghan Poppy for Medicine
projects could fill is considerable.
Figure 3: Afghan total opium production, 1994-2006 (metric tonnes)

7000
6000
6100
5000
4600
4000
3000
3400
2000
2300
2800
2200
3300
3400
3600
2002
2003
4200
4100
2004
2005
2700
1000
185
0
1994
1995
1996
1997
1998
1999
2000
2001
2006
86
See Table 4 and B Fischer, J Rehm, and T Culbert, Opium based medicines: a mapping of global
supply, demand and needs in Spivack D. (ed.) Feasibility Study on Opium Licensing in Afghanistan,
Kabul, 2005, p.79, [online]. Available at:
87
It is calculated that to meet 100% of all patients pain needs around the world in 2005 at the same
morphine consumption rate as Western European patients that year, at least 607.5 metric tons of
morphine would have been needed, representing 6075 metric tons of opium. In 2005, the morphine
consumption rate in Western Europe stood at 24.02 mg per capita. According to research, this figure
represents just 24% of actual need: if 100% of pain needs in Western Europe were being met, the per
capita consumption rate would be nearly 100mg. Using this figure as a baseline, if all patients suffering
from pain around the world had had their pain needs at the same rates as Western European patients,
615 metric tons of morphine would have been required.
Increasing global morphine consumption to meet actual global need
Region
Current
annual
consumption per capita
in 2005 (mg)
Total need for morphine-based

medicines, assuming a consumption
of 100 mg per capita
Quantity of morphine needed to

increase
annual
per
capita
consumption to 100 mg
(mt)
Quantity of opium
needed to make this
morphine
(mt)
North
America
55.50
33
15
148
Western
Europe
24.02
39
World
4.90
647
29
615
294
6,152
98
June 2007
Part B2
Afghan-made medicines to be sold under a second-tier
medicine supply system for emerging countries
99
June 2007
100
B2
June 2007

Summary
An analysis of the global un-met need for morphine shows there is a substantial
market for Afghan-village made medicines. Research indicates that the current INCBadministered raw poppy materials supply system should be complemented by an
additional second-tier system for the supply of finished poppy-based medicines.
Leveraging the expertise and resources of farmers in Afghanistan to produce and
export Afghan locally-produced morphine, this additional second-tier system, by
making available affordable medicines, could help meet the needs of the 80% of the
worlds population who currently have little or no access to these essential painkilling medicines.
101
June 2007
102
June 2007

1.1
The need for a second tier of medicines supply to complete current system
As the current system supplies demand levels as reported by the INCB but does not
cover the global actual need, there is room for a complementary second tier system
of supply that would be based on the production of poppy-based medicines offered at
affordable prices. This second tier supply system is needed to help meet the
developing worlds growing need for inexpensive poppy-based medicines.
While only a limited number of countries are authorised by the INCB to export the
raw materials used in the manufacture of poppy-based medicines, any country is
allowed to manufacture such medicines, regardless of whether these medicines are for
internal use or for export. Thus a second-tier supply system based on the export of
finished poppy-based medicines rather than the export of raw poppy materials could
easily be established. So as to not disrupt the current global supply system or attempt
to replace current suppliers of raw poppy materials, a second-tier system would only
supply finished poppy-based medicines to less economically developed countries
lacking access to these essential medicines.
Two-tier systems are currently in place around the world for commodities as diverse
as generic HIV/AIDS medicines and bananas. Multi-level systems of product supply
are used to channel like products to distinct markets. A second tier system of product
supply is most useful where a significant sector of consumers are disconnected from
the overall market for that product, having been either priced out, or ignored
altogether. Two-tier product supply structures are particularly useful for making
essential medicines more widely available.
In particular, supplies of HIV/AIDS and malaria medicines are sold through two
different systems of supply: brand-name, higher cost drugs are made available to
wealthier markets; cheaper, generic medicines are supplied to less well-developed
103
June 2007
economies. For example, in Sub-Saharan Africa, the bulk of the medicines88

consumed by HIV/AIDS patients are generic medicines, sold at prices much lower
than those charged for branded drugs, which are generally only used if generic first
line medicines fail.89
Likewise, two-tier supply systems are used to enhance the availability of medicines
used in the treatment of those so-called neglected diseases most prevalent in
emerging or transitional economies, such as malaria. Because the supply of potent
malaria-treatment drugs was not reaching many patients who most needed them, a
new system of supply was developed to meet these un-met needs.90
The implementation of Afghan village-based Poppy for Medicine projects would

effectively facilitate the development of a second market for fair trade village-based
Poppy for Medicines market supplied by Afghanistan, outside the current INCB
administered market. Farmers in the current supply countries who cater to the current
market would in no way be affected by the production of village-based Poppy for
Medicines. Afghan locally-produced morphine supplies would not compete with
existing suppliers, because it would be geared for those countries who do not actually
take part in this existing market. Morphine produced under an Afghan village-based
Poppy for Medicine project would provide these countries that currently have little or
no access to these essential medicines with an affordable, high-quality supply of
effective painkillers for their AIDS and cancer patients.
88
Such as Anti-Retro Viral therapies (ARVs).

According to numbers reported to the Global Price Reporting Mechanism at the World Health
Organisation, generic companies supplied 63% of the HIV/AIDS drugs to Sub Saharan; these generic
drugs commanded, on average about one third of the price that brand companies charged. See Colleen
V. Chien, HIV/AIDS Drugs for Sub-Saharan Africa: How Do Brand and Generic Supply Compare?
Fenwick & West LLP, US, pp. 2-3, [online] Available at:
http://www.plosone.org/article/fetchArticle.action;jsessionid=4119F88A206260D0EBC977352635DF
E4?articleURI=info%3Adoi%2F10.1371%2Fjournal.pone.0000278
90
This system is based on the manufacture and supply of malaria treatment medicines, specially
adapted for use in developing countries. Coordinated by the non-profit Drugs for Neglected Diseases
Initiative and French pharmaceutical company Sanofi Aventis, this second-tier supply system channels
essential medicines to a previously neglected market. Mdecins Sans Frontires MSF welcomes news
of new combination drug to treat malaria, 8 April 2005, [online] Available at:
http://www.msf.org/msfinternational/invoke.cfm?component=pressrelease&objectid=4783B5C6-E0180C72-0996723C59E71DDE&method=full_html
89
104
1.2
June 2007
Channelling Afghan-made medicines to the international market through

special trade agreements
Under the 1961 Single Convention on Narcotics Drugs, where a country cultivates
poppy for its own domestic use in poppy-based medicines, it is not necessary to obtain
any formal approval from any United Nations agency or from the International
Narcotics Control Board. The only requirement is the establishment of a national
agency to oversee the production of the Poppy for Medicine process.91 This holds true
even where the morphine that is produced is subsequently exported. There are no
legal obstacles stemming from the 1961 Convention, the World Trade Organisation
(WTO) or European Union regulations or domestic state laws to the trade of finished
poppy-based medicines through special trade agreements.92 Thus, special trade
agreements would enable the sale of Afghan morphine within the frame of current
regulatory constraints.
Special trade agreements for Afghan-made medicines

Sales contracts between State Enterprises: The use of State-owned enterprises to
make contracts avoids the issues of immunity and sovereignty associated with direct
contracts of sale between States. Although they are controlled by the state, Stateowned enterprises are separate entities which acquire rights and obligations in their
own name. Such enterprises are frequently used as a tool for carrying out commercial
activities in areas where a State wishes to retain involvement. The 1961 Convention
specifically provides for the international trade of narcotic drugs through State
enterprises.93 In order to be compatible with WTO regulations these enterprises must
demonstrate that import/export of poppy based medicine follows commercial
considerations.94
Revenue Sharing Agreement (RSA): Another option would be to set up a
commercial contract between Afghanistan or its State enterprise and a company of a
91
While the state should inform the INCB of the establishment of any such agency, the state does not
need INCB approval to do so.
92
Roadmap: International Trade Law Aspects of Exporting Morphine and Codeine from Afghanistan.
British Institute of International and Comparative Law, 9-11-07, pp.37-40, [online] available at:
http://www.biicl.org/morphine/
93
Ibid. p 41.
94
General Agreement on Trade and Tariffs, Article XVII: 1(b). See: Roadmap: International Trade
Law Aspects of Exporting Morphine and Codeine from Afghanistan. British Institute of International
and Comparative Law, 9-11-07, p. 63, [online] available at: http://www.biicl.org/morphine/
105
June 2007
third State, which would provide details on how the revenue generated by the
company through the export of Afghan-made medicine would be shared with the
Afghan producers. This may be done through a joint venture enterprise, or through an
Afghan subsidiary owned entirely by a foreign investor. Because an RSA is a
commercial contract, this option does not raise any legal issues pertaining to the
regulations or the regulatory bodies discussed above. Furthermore, the flexibility of an
RSA would allow contracts to be tailored to economic, social and development needs.
It would also provide for the free transfer of technology and expertise for the
production and export of Afghan produced poppy based medicine.95
95
Ibid. p 45.
106
June 2007
Part B3
Pilot projects to test use of Afghan-made medicines
107
June 2007
108
B3
June 2007
Pilot projects needed to test the use of Afghan-made

morphine
Afghan Poppy for Medicine pilot projects could help meet the need for affordable and
reliable pain-relieving medicines in emerging countries. The establishment of a
second-tier supply system through special trade agreements would allow medicines to
reach patients that would otherwise not have access to morphine. 96 This second-tier
supply system however, would also need to be tested at the consumer end. Linked to
the Pilot Poppy for Medicine projects, Pilot Projects should be implemented in
selected locations in emerging countries to ensure that the production of affordable
Afghan-made morphine does actually result in increased access to morphine where
such access is most needed.
Brazil: a Pilot Project to provide pain relief

Pilot Projects for the use of Afghan-made morphine medicines in Brazilian hospitals
could target local populations lacking access to pain-relieving medicines. Finished
medicines imported from Afghanistan could be bought by the Brazilian Ministry of
Health, who would be able to provide target communities with inexpensive medicines.
Afghan morphine would need to be adequately presented and priced so as to bring
about sufficient willingness to use it. Prescription could be fostered by the WHO,
while the Brazilian Red Cross could contribute to the appropriate pricing and review
the final use of the medicines.
Afghan-made morphine consumer-end Pilot Projects could be integrated with WHO

efforts to increase the use of poppy-based medicines in emerging countries. As such
they could benefit from the WHOs expertise and usefully contribute to the WHOs
stated objectives. Indeed, fair trade Afghan morphine should help address the price
issues that limit the prescription and thus use of these essential medicines around the
world.
96
Such a second-tier system to supply morphine medicines to developing countries would complement
the existing system which supplies morphine to developed countries.
109
June 2007
A Pilot Project would enable an assessment to be made of the extent to which Afghanmade medicines can be made available to populations otherwise lacking appropriate
treatment of their pain. A Pilot Project would also examine whether Afghan-made
morphine is reliable and affordable enough to respond to some of the currently un-met
need for pain-relieving medicines.
Supplying morphine to UN agencies and international NGOs

Whether working with developing countries national health authorities, or organising
the medical response to natural or human disasters in crisis-ridden countries, UN
agencies and international NGOs such the International Red Cross play an important
role in the procurement of essential drugs such as morphine. International aid agencies
and organisations represent a stable potential market for Afghan-made morphine.
The UN Inter-Agency Procurement Service (IAPSO) is the self-funding procurement

agent for a range of UN agencies, NGOs and international financial institutions. In
2006, USD 8.5 million of medical supplies were bought through the IAPSO, and in
2005, 43.1% of goods were procured from emerging countries. Equally, tenders for
contracts can be made directly to a specific UN agency. The UN Global Marketplace
also provides a shortlist of potential suppliers available to UN agencies.
The WHO and the UN are equally involved in the construction of national
procurement agencies in less economically developed countries; national governments
can either utilise their own procurement agencies or call upon the services of a public
or private agency. These agencies purchase the medicines on behalf of the Ministries
of Health for their respective countries, who then authorise the import of the drug.
Eighty percent of antiretroviral (ARVs) used by Mdecins sans Frontires are
purchased in India. These figures are similar to the percentage of ARVs purchased by
UNICEF, IDA and the Global Fund.
Affordable Afghan-made morphine, produced through a Pilot Poppy for Medicine
Project could provide a competitive solution for international aid agencies involved in
the procurement of both large and smaller orders of pain relieving drugs.
110
June 2007
111
June 2007
112

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Licensing poppy cultivation for the production of essential

Afghan village-based Poppy for Medicine projects

Afghan village-based Poppy for Medicine projects

Morphine: a simple poppy-derived pain medicine remains the worlds

Part A: Poppy for Medicine: an integrated counter-narcotics and

Reining in the Afghan Poppy through the integrated control of

Controlling the implementation of Poppy for Medicine projects

Who are the key players in the Integrated Control System?

Key concept in Poppy for Medicine projects: Village Control

Controlled planning of individual village-level Poppy for Medicine projects

Controlling each project phase: policing responsibilities and penalties

Integrated Control of Poppy for Medicine project

Bringing economic development at the village level

The economics of Poppy for Medicine Projects: production and sale of

Afghan National Pharma Company: International Morphine Traders

Afghan village-based Poppy for Medicine projects

The economic vehicle of Poppy for Medicine projects: cooperative

Economic Diversification through Poppy for Medicine projects

Providing the resources and incentives necessary to phase out reliance on

Foiling the corruption associated with counter-narcotics efforts

Immediately bridging security and development in Afghanistan

Scientific Pilot Projects

Control and Legal Framework

Timeline, Planning and Implementation

Number and Location of Pilot Projects

Part B: Afghan-made medicines to meet the global need for

Demand and supply: the current poppy-based medicines production system

Un-met need for painkillers in Latin America

The global un-met need for morphine

WHO efforts to increase prescription of poppy-based medicines

Afghan morphine needed to meet actual global need for painkillers

Afghan village-based Poppy for Medicine projects

Afghan medicines to be sold under a second-tier system of medicine

Channelling Afghan-made medicines to the international market through

special trade agreements

Special trade agreements for Afghan-made medicines

Pilot projects needed to test the use of Afghan-made morphine

Brazil: a Pilot Project to provide pain relief

Supplying morphine to UN agencies and international NGOs

Afghan village-based Poppy for Medicine projects

Afghan village-based Poppy for Medicine projects

Current counter-narcotics policies are risking mission failure in Afghanistan

Afghan village-based Poppy for Medicine projects

Local leader, Kama District, Nangarhar Province, May 20061

Afghan village-based Poppy for Medicine projects

Integrated security systems provide maximum physical and quality control

Creating vested interests in the Poppy for Medicine project

Afghan village-based Poppy for Medicine projects